RESUMEN
The model AS800 artificial urinary sphincter was implanted in 56 patients with urinary incontinence after transurethral resection of the prostate and in 8 patients after open prostatectomy. Their ages ranged from fifty-three to eighty-seven years (mean, 70 years). At presentation, 92 percent had total incontinence and 8 percent had distressing stress incontinence. Fifteen patients (23%) had had previous radiation therapy. Bulbous urethral cuffs were used in 60 (94%) patients and vesical neck cuffs in 4 (6%). Follow-up questionnaires were mailed to assess satisfaction rate and degree of continence. Continence was significantly improved in 90 percent, and 87 percent of the patients were satisfied with their sphincters. Surgical revisions were required in 14 patients (22%). Cuff compression was inadequate in 9 patients, and erosion led to revision in 3 patients. At follow-up, 3 patients had had at least one component of the AS800 removed (complete device in 2 and cuff in 1).
Asunto(s)
Incontinencia Urinaria/cirugía , Esfínter Urinario Artificial , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Prostatectomía/efectos adversos , Prostatectomía/métodos , Reoperación , Incontinencia Urinaria/etiología , Esfínter Urinario Artificial/efectos adversosRESUMEN
The model AMS800 artificial urinary sphincter was implanted in 117 patients with urinary incontinence resulting from radical prostatectomy. The indication for implantation was total incontinence in 107 patients and stress incontinence in 10. All patients had bulbous urethral cuff insertion and 20 had previous pelvic irradiation. Followup questionnaire indicated a 90% significantly improved continence rate and a 90% satisfaction rate among patients. There were 64 surgical revisions required in 37 patients: inadequate cuff compression in 21 (33%), tubing kinks in 10 (16%), urethral cuff erosion in 8 (13%), scrotal hematoma in 6 (9%), control assembly malfunction in 4 (6%) and cuff leaks in 4 (6%). Of the 20 patients with previous pelvic radiation 2 (10%) had at least 1 erosion, compared to 5 of 97 (5%) in the nonirradiated group. At followup 5 patients did not have at least 1 component of the AMS800 device indwelling (2 cuffs and 3 entire devices had been removed).
Asunto(s)
Complicaciones Posoperatorias/cirugía , Prostatectomía , Prótesis e Implantes , Uretra/cirugía , Incontinencia Urinaria/cirugía , Comportamiento del Consumidor , Estudios de Seguimiento , Humanos , Masculino , Prótesis e Implantes/efectos adversos , Falla de Prótesis , Reoperación , Encuestas y CuestionariosRESUMEN
Two unusual cases of neurofibromatosis are presented. The symptoms, focal perineal pain, and urethral burning, mimicked chronic prostatis or prostadynia. The cause of perineal pain is often baffling. The patients described had a very specific reason for their discomfort, which proved to be involvement of the peripheral nerves of the perineum by plexiform neurofibromas. Neurofibromatosis should be considered in the differential diagnosis of perineal pain, especially when palpable nodules are present.
Asunto(s)
Neurofibromatosis 1/complicaciones , Dolor/etiología , Parestesia/etiología , Perineo/inervación , Neoplasias del Sistema Nervioso Periférico/complicaciones , Uretra/inervación , Adulto , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The American Medical Systems inflatable penile prosthesis has undergone periodic design changes to improve device reliability and longevity while maintaining a high degree of patient and partner satisfaction. Previous data reported from this institution did not consider these frequent design changes and the assessment of device reliability incorporated consecutive cases involving several different designs. This study was designed to evaluate followup data on 120 patients who received the model 700 inflatable penile prosthesis, permitting assessment of device reliability of a single design. Two groups were evaluated: a pre-fix group of 57 patients and a post-fix group of 63 patients. Over-all, 11.7 per cent of the total group required revision (21 per cent of the pre-fix and 3.2 per cent of the post-fix groups). Careful life-table analysis of the results with the current model 700 device (post-fix) reveals that this model has a 97 per cent chance of maintaining normal mechanical function for 3 years. Further assessment of these patients in the future will provide additional data on long-term reliability of this design.