Le sphincter artificiel urinaire chez l'homme a propos de 23 cas The artificial urinary sphicter in the male - a study of 23 cases

Objectives: To evaluate our experience with the placement of artificial urinary sphincters and to review the literature about the indications, additional measures required and prognosis of the device. Patients and Methods : This retrospective study was based on 23 male patients who received artificial urinary sphincters of the AMS 800 type at the University Hospital of Dupuytren, Limoges, between April 1996 and April 2005. The mean age of our patients was 70.3 years (range 47 to 77 years). Eight patients had been treated previously by pelvic radiotherapy for prostate cancer. Sphincter insufficiency occurred following radical prostatectomy in 10, endoscopic resection of a prostatic adenoma in 5, transvesical adenectomy in 4 and endoscopic sphincterotomy with bladder augmentation in 2 patients, as well as following external radiotherapy for the treatment of a localized prostatic adenocarcinoma stage T2a in one and a cystoprostatectomy with Camey II type bladder replacement in the remaining case. Routine investigations included urine analysis, assessment of a possible concomitant inflammation or infection, urethroscopy and a urodynamic work-up. Pelvic floor training was done in all cases, while macroplastique was administered in 15 cases only. Finally, an artificial sphincter was placed in periurethral position in all cases. Results: The functional results of the artificial sphincter were assessed 6 months after activation of the sphincter and were based on the clinical results as well as on the patient's satisfaction. Eighteen out of our 23 patients are completely satisfied, while the 5 remaining patients report minimal urinary leakage. One of them reported a reduction of urinary flow. In 9 cases late complications were noted; three of them could be easily repaired (a technical problem caused by high pressure in the balloon, one minimal vesico-parietal fistula and migration of the pump needing reposition). The 6 remaining cases suffered from urethral erosion caused by the cuff of the device which incurred within a mean time of 5 years following the placement of the artificial sphincter. Conclusion: The high rate of satisfaction reported by the patients has proved the efficacy of the AMS 800 artificial sphincter in the treatment of urinary incontinence caused by sphincteric insufficiency. Nevertheless, a number of failures is still reported. They may cause severe complications eventually leading to the removal of the device, especially in cases of erosion. For this reason, it is mandatory to respect the indications, to carefully select the patients and to ensure an adequate follow-up to avoid any late complications. Résumé Objectif: Evaluer notre expérience dans la mise en place des sphincters artificiels urinaires (SAU). Discuter, après une revue de la littérature, les indications, les examens complémentaires et le pronostic. Patients et méthodes: Il s'agit d'une étude rétrospective, à partir de 23 cas de sphincters artificiels type AMS 800, posés