Permanent Bulbar Urethral Ligation: Emerging Treatment Option for Incontinent Men with End-Stage Urethra

Abstract Objective To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra. Methods From our institutional Artificial Urethral Sphincter (AUS) database of 512 patients from 2010–2016, 10 men underwent permanent urethral ligation with concurr...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2017-07, Vol.105, p.186-191
Main Authors: VanDyke, Maia E, Viers, Boyd R, Pagliara, Travis J, Scott, Jeremy M, Shakir, Nabeel, Dugi, Daniel D, Cordon, Billy H, Hofer, Matthias D, Morey, Allen F
Format: Article
Language:English
Subjects:
Aged
Humans
Ligation - methods
Male
Middle Aged
Quality of Life
Retrospective Studies
Treatment Outcome
Urethra - surgery
Urinary Incontinence, Stress - etiology
Urinary Incontinence, Stress - surgery
Urinary Sphincter, Artificial
Urology
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Summary:Abstract Objective To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra. Methods From our institutional Artificial Urethral Sphincter (AUS) database of 512 patients from 2010–2016, 10 men underwent permanent urethral ligation with concurrent suprapubic tube (SPT) diversion following recurrent AUS cuff erosion. Clinical characteristics and outcomes were evaluated. Quality of life (QOL) was assessed using the Michigan Incontinence Symptom Index (M-ISI) and the Patient Global Index of Improvement (PGI-I). Results Urethral ligation resulted in resolution of incontinence in 8 men (80%), including 7 (70%) after one surgery and in 1 other (10%) after a single revision. The average American Society of Anesthesiologists (ASA) physical status rating was 2.7 (range 2-3). Seven patients (70%) experienced post-operative complications [4 Clavien-Dindo Grade II complications (1 Clostridium difficile infection, 3 with refractory bladder spasms) and 5 Grade III complications (2 abscesses, 2 urethrocutaneous fistula, and 1 bladder stone formation)]. Overall, satisfactory M-ISI urinary scores were reported in 8 (80%) men. On PGI-I, 6 (60%) reported improvement in overall condition following surgery. All men (10/10) stated that they would recommend this procedure to others. Conclusions For debilitated men with end-stage urethra and severe refractory stress urinary incontinence (SUI), permanent urethral ligation with chronic SPT drainage can restore continence and improve QOL without the need for more invasive formal urinary diversion, though with a high risk of complication.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2017.02.042