RAMB - AGOSTO 2017

ruzzi

672

ssoc

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2017; 63(8):664-680

There is no evidence to support routine oral antimi-

crobial therapy postoperatively, especially in the absence

of catheter placement and/or patient risk factors.

(D)

The

periods of oral antibiotic therapy (quinolones, cephalospo-

rin or trimethoprim-sulfamethoxazole) in the postoperative

period of AUS implantation vary in terms of extension, and

are inconsistently reported in before-and-after studies.

67-70

(C)

Meta-analyses of inguinal hernia repair using mesh

(A)

and orthopedic surgery

(A)

confirm that antimicro-

bial prophylaxis is beneficial when foreign material is im-

planted. A prolonged course of antimicrobials has been

used by many professionals after penile prosthesis insertion,

but evidence from orthopedic literature suggests that pro-

phylaxis for 24 hours or less is adequate.

(D)

Trauma caused by catheterization or endoscopic ma-

nipulation in patients with an activated or malfunction-

ing device are considered as potential causes of urethral

lesions, facilitated by tissue devascularization due to

urethral athrophy.

26,72,73

(C)

Even catheters suitably placed

for short periods can be detrimental to the long-term

survival of the device. Authors have demonstrated a great-

er risk of erosion in patients who were catheterized for

more than 48 hours at any time after the placement of

the AUS.

(C)

Therefore, in situations when catheteriza-

tion is absolutely necessary, a catheter of the appropriate

caliber should be put in place for the shortest possible

period of time (although there is no definition of how

many days it should remain and this varies depending on

the clinical situation). Intermittent urinary catheterization

is not a contraindication in the presence of an artificial

urinary sphincter, as long as the cuff remains deflated dur-

ing the procedure.

(D)

Most patients undergoing inter-

mittent catheterization are neurogenic, so the cuff is usu-

ally placed around the neck of the bladder, reducing the

risk of urethral erosion in comparison with positioning

in the bulbar urethra.

(C)

(D)

The AUS must remain deactivated for six weeks. The

first postoperative clinical visit occurs between 1-2 weeks,

when the abdominal and perineal incisions are inspected,

assessing the integrity of the skin and the possibility of

infection. At the 6-week follow-up, the sphincter is acti-

vated by applying a firm and strong grip to the control

pump, with the patient being instructed in the proper use

of the device by the physician.

(D)

Difficulty in handling

the pump leads to inadequate emptying of the cuff, which

is the most common cause of postoperative urinary incon-

tinence and sphincter malfunction. In order to identify

early complications requiring revision in the first few

months of use, 3- and 6-month visits are the most critical,

with subsequent frequency adjusted based on individual

clinical circumstances. Ideally, standard follow-up should

be conducted annually.

(D)

The immediate identification

of infection and/or erosion facilitates intervention before

other local or systemic consequences occur. Some surgeons

advocate nighttime sphincter deactivation, but others

believe that this approach is ineffective and imposes un-

necessary nighttime incontinence on the patient. A study

comparing the two approaches demonstrated a tendency

towards a decrease in atrophy with nocturnal deactivation,

but the study does not have sufficient power and does not

achieve statistical significance (ARR = 27%, 95CI -0.056 to

0.600; NNT = NS; power = 33.57%).

(A)

Global evidence summary

Perioperative antibiotics are routinely administered; how-

ever, there is no standard antibiotic regimen.

(D)

It is recommended to provide both Gram-positive and

Gram-negative coverage, including coverage for methicillin-

-resistant

Staphylococcus

spp. This should be administered

within 60 minutes before cutaneous incision.

(D)

Alcohol chlorhexidine solution reduces the presence

of coagulase-negative staphylococci at the surgical site,

and is better than iodopovidone (topical PVP-I).

(A)

There is no evidence to support routine oral antimi-

crobial therapy postoperatively, especially in the absence

of catheter placement and/or patient risk factors.

(D)

Trauma caused by catheterization or endoscopic ma-

nipulation in patients with an activated or malfunction-

ing device are considered as potential causes of urethral

lesions.

(C)

In situations where catheterization is absolutely nec-

essary, it is important to place a catheter of the appropri-

ate caliber for as short a time as possible.

(C)

Intermittent urinary catheterization is not a contra-

indication in the presence of an artificial urinary sphinc-

ter, provided that the cuff remains deflated during the

procedure.

(D)

The first postoperative clinical visit takes place with-

in 1-2 weeks. The device should remain disabled for six

weeks after surgery.

(D)

In order to identify early complications requiring

revision in the first few months of use, 3- and 6-month

visits are the most critical, with subsequent frequency

adjusted based on individual clinical circumstances.

(D)

Standard follow-ups should be performed annually.

(C)

6. E

valuation

and

conduction

therapeutic

failure

after

AUS

implantation

The objective of this evaluation is to assess the best con-

duct in the management of therapeutic failure (early or