RAMB - AGOSTO 2017

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2017; 63(8):664-680

and O stands for the outcome of control of incontinence

and complications. Based on the structured question,

keywords were identified and constituted the basis of the

search for evidence in the databases. After applying the

eligibility criteria (inclusion and exclusion), articles were

selected in order to respond the clinical doubt (Annex IV).

Results

In all, 1,757 studies were retrieved; ten were selected by

title and eight by summary, with reading of the full text

in the second case. After the analysis of the full texts, six

studies were included in our evaluation.

9,51-55

The main

reasons for exclusion were: studies aiming only to describe

the surgical technique, a series of cases with a small num-

ber of patients included (n < 10), and a narrative review.

The transcorporal approachwas introduced by Guralnick

ML et al. in an effort to treat patients with previous urethral

atrophy or erosion. In a before-and-after study, the results

after transcorporal cuff placement were reviewed in 31

patients with an average follow-up of 17 months. A success

rate of 84% (26 of 31 patients) was reported, defined as

patients with no incontinence or occasional incontinence,

requiring 0 to 1 pad per day. In addition, 25 of 26 patients

surveyed were very satisfied with the outcome. It is note-

worthy that seven of these patients had undergone pri-

mary double cuff placement. There were no cases of infec-

tion or erosion. Of the 31 patients, 27 had no preoperative

erectile function, one had normal erections, one had partial

erections with the intra-urethral drug delivery system and

two had a penile prosthesis. Postoperative erectile function

deteriorated in one patient and remained unchanged in

the others.

(C)

A historical cohort increased the original indications,

including not only patients requiring reimplantation

around the distal bulbar urethra, but also those submit-

ted to primary cuff placement in the proximal bulbar

urethra, with a history of radiotherapy or with a high risk

of erosion by the cuff due to previous urethral mobiliza-

tion for urethroplasty (N = 30; 26 with prostate cancer

therapy). Twenty-six (26) patients were compared: 18 with

“cuff standard setting” versus eight with “transcorporal

approach,” after a minimum follow-up of 12 months and

a mean follow-up of 31 and 28 months, respectively. Ap-

proximately 50% of these patients had a history of radio-

therapy. Most of the patients in the transcorporal group

had two or more urethral surgeries prior to AUS placement,

with a primary indication for TC prior anastomotic ure-

throplasty. Success rates for social continence (< 2 pads

per day) were 61% using the standard approach and 87.5%

for the transcorporal group (NNT = NS [not statistically

significant]). AUS device explantation due to erosion or

infection, retention (need for urethral catheter or supra-

pubic cystostomy), atrophy and incontinence were more

common in the standard technique group. However, the

data should be interpreted with caution (NNT = NS for

all outcomes), since neither group is balanced. The results

of this study showed that the TC group, despite a higher

rate of previous urethral surgery and radiotherapy, has

reasonable results.

(B)

In another study, authors evaluated data from 30 pa-

tients identified as having a “fragile urethra” post-prosta-

tectomy (pelvic irradiation, prior AUS implant failure,

previous urethroplasty or cystoscopic and/or clinical find-

ings of urethral atrophy). Thirteen (13) of these patients

underwent transcorporal AUS (TCAUS) and 17 had a

“standard” approach to the cuff. Seventeen (17) patients

had irradiation, eight had erosion and ten had previous

urethroplasty. Five patients had multiple risk factors for

urethral erosion. The follow-up time was 34.1 months

(range 2-95 months) and 42.2 months (range 4-94 months)

in the “standard” and TCAUS groups, respectively. When

the TCAUS and “standard AUS” groups were compared,

there was no difference in continence rates (≤ 1 pad/day)

(NNT = NS), improvement (any reduction in the number

of pads/day) (NNT = NS), explantation (NNT = NS) or

erosion (NNT = NS), despite a higher proportion of previ-

ous urethroplasties in the TCAUS group.

(B)

The authors prospectively evaluated incontinence

control and erectile function after prior surgical failure

using the TC approach in AUS cuff implantation. 23

patients with a mean age of 70 were included (age [SD],

60-85 [7]). Of these, 18 patients had urethral atrophy and/

or erosion after AUS placement (11 patients), male sling

(four patients) or both (three patients), and five patients

had severe urethral atrophy after pelvic radiotherapy.

There were no perioperative complications. After an aver-

age follow-up of 20 months (2-59 [15]) including data

from 17 patients, eight were perfectly dry (no pads and

no symptoms), five achieved social continence (0-1 pad/

day) and four still had incontinence (required two or more

pads/day). Among the six patients who had good preop-

erative erectile function and were sexually active, four had

no decrease in the International Index of Erectile Function

Questionnaire (IIEF-5) score. Therefore, TC cuff place-

ment is a useful alternative after failure of prior surgical

treatment, urethral atrophy or erosion. Erectile function

can be maintained using the TC approach.

(C)

Of the 37 male patients treated with transcorporal

AUS cuff, 20 had primary placement of transcorporal cuff,

one of them with surgical indication due to previous