[Influence of urethral self-dilatation on the morbidity of the artificial urinary sphincter after endoscopic treatment of recurrent stenosis of the vesicourethral anastomosis]

Abstract

Objective: To analyze the morbidity of the practice of daily self-dilatation (SD) in patients undergoing total prostatectomy, who have had artificial urinary sphincter (AUS) for urinary incontinence (UI) and who have had a recurrence of endoscopically treated vesicourethral anastomosis (VUS) stenosis.

Materials and method: One hundred and thirty-eight patients with SUA for urinary incontinence (UI) fitted between 1998 and 2007 were divided into two groups. Thirty-five patients have had used self-dilatation (SD) for recurrent anastomotic stenosis (SD group) and 103 patients did not perform SD (non-SD group). These two groups were compared for explantation rate (erosion-infection), revision rate (urethral atrophy and mechanical failure) and 2-year functional results. The uni- and multivariate statistical analysis taken into consideration confounding factors such as age and radiotherapy history. The functional assessment was done by the validated IQoL, Ditrovie and MHU tests.

Results: Patients in both groups were comparable except for the importance of urinary incontinence assessed by PAD test and questionnaires. The explantation rate was significantly higher in the "SD" group (28.5% vs 7.77%) and (OR=4.68, 95% CI [1.490-15.257], P=0.006). There was no significant difference between the two groups in the surgical revision rate (32% vs 20%, OR=0.44, P=0.09). The functional results at two years did not show any significant difference.

Conclusions: The use of self-dilation for recurrence of stenosis of vesicourethral anastomosis after prostatectomy exposes patients fitted with an SUA to a higher explantation rate.

Level of evidence: 3.

Keywords: AUS; Artificial urinary sphincter; Autodilatation urétrale; SUA; Sphincter urinaire artificiel; Sténose anastomose vesico-uretrale; Urethral self-dilation; Vesicourethral anastomotic stenosis.