Khene ZE, et al. - An assessment was pursued of the perioperative and long-term functional outcomes of the bladder neck and peribulbar cuff placement of an artificial urinary sphincter (AUS) in adult male patients with spinal dysraphism. It was determined that the morbidity and functional consequences were similar between bladder neck and bulbar urethra cuff placement, among spina bifida (SB) male patients. However, a trend was reported pointing towards a longer survival without explantation in the bladder neck group. The only predictor of shorter device survival in multivariate analysis was the clean-intermittent catheterization.

Methods

• During this trial, a retrospective analysis was conducted of the French spina bifida (SB) network database.
• It recruited patients who underwent implantation of an AUS from January 1985 to November 2015.
• The enrollees were stratified into two groups according to cuff location: Bladder neck vs. bulbar urethra.
• An estimation was carried out of the explantation-free and revision-free device survivals through the Kaplan-Meier method.
• The log rank test undertook the comparative assessment.
• Cox regression models gauged the prognostic factors of AUS device failure.

Results

• This research constituted 65 patients.
• A majority of the patients were not wheelchair-bound.
• The cuff was implanted around the bulbar urethra in 46 procedures (59%) and around the bladder neck in 32 procedures (41%).
• It was disclosed that the median revision-free device survivals were 11.7 and 14.3 years (p=0.73) and median explantation-free device survivals were 18.5 and 24.5 years (p=0.08) in peribulbar and bladder neck groups respectively.
• Clean-intermittent catheterization served as the only predictor of AUS device failure (no influence of cuff location), in the multivariate analysis.
• Both groups illustrated similar satisfactory continence (83% vs. 75%, p=0.75), at the last follow-up.