Permanent Bulbar Urethral Ligation: Emerging Treatment Option for Incontinent Men With End-stage Urethra

Maia E. VanDyke, Boyd R. Viers, Travis J. Pagliara, Jeremy M. Scott, Nabeel Shakir, Daniel Dugi, Billy H. Cordon, Matthias D. Hofer, Allen F. Morey

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra. Materials and Methods From our institutional artificial urinary sphincter database of 512 patients from 2010 to 2016, 10 men underwent permanent urethral ligation with concurrent suprapubic tube diversion following recurrent artificial urinary sphincter cuff erosion. Clinical characteristics and outcomes were evaluated. Quality of life was assessed using the Michigan Incontinence Symptom Index and the Patient Global Index of Improvement. Results Urethral ligation resulted in resolution of incontinence in 8 men (80%), including 7 (70%) after 1 surgery and in 1 (10%) after a single revision. The average American Society of Anesthesiologists physical status rating was 2.7 (range 2-3). Seven patients (70%) experienced postoperative complications (4 Clavien-Dindo grade II complications [1 Clostridium difficile infection, 3 refractory bladder spasms) and 5 grade III complications (2 abscesses, 2 urethrocutaneous fistula, and 1 bladder stone formation]). Overall, satisfactory Michigan Incontinence Symptom Index urinary scores were reported in 8 (80%) men. On the Patient Global Index of Improvement, 6 (60%) men reported improvement in overall condition following surgery. All men (10/10) stated that they would recommend this procedure to others. Conclusion For debilitated men with end-stage urethra and severe refractory stress urinary incontinence, permanent urethral ligation with chronic suprapubic tube drainage can restore continence and improve quality of life without the need for more invasive formal urinary diversion, though with a high risk of complication.

Original languageEnglish (US)
Pages (from-to)186-191
Number of pages6
JournalUrology
Volume105
DOIs
StatePublished - Jul 1 2017

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Urethra
Ligation
Artificial Urinary Sphincter
Therapeutics
Quality of Life
Urinary Bladder Calculi
Clostridium Infections
Urinary Diversion
Stress Urinary Incontinence
Clostridium difficile
Spasm
Abscess
Fistula
Drainage
Urinary Bladder
Databases

ASJC Scopus subject areas

  • Urology

Cite this

VanDyke, M. E., Viers, B. R., Pagliara, T. J., Scott, J. M., Shakir, N., Dugi, D., ... Morey, A. F. (2017). Permanent Bulbar Urethral Ligation: Emerging Treatment Option for Incontinent Men With End-stage Urethra. Urology, 105, 186-191. https://doi.org/10.1016/j.urology.2017.02.042

Permanent Bulbar Urethral Ligation : Emerging Treatment Option for Incontinent Men With End-stage Urethra. / VanDyke, Maia E.; Viers, Boyd R.; Pagliara, Travis J.; Scott, Jeremy M.; Shakir, Nabeel; Dugi, Daniel; Cordon, Billy H.; Hofer, Matthias D.; Morey, Allen F.

In: Urology, Vol. 105, 01.07.2017, p. 186-191.

Research output: Contribution to journalArticle

VanDyke, ME, Viers, BR, Pagliara, TJ, Scott, JM, Shakir, N, Dugi, D, Cordon, BH, Hofer, MD & Morey, AF 2017, 'Permanent Bulbar Urethral Ligation: Emerging Treatment Option for Incontinent Men With End-stage Urethra', Urology, vol. 105, pp. 186-191. https://doi.org/10.1016/j.urology.2017.02.042
VanDyke, Maia E. ; Viers, Boyd R. ; Pagliara, Travis J. ; Scott, Jeremy M. ; Shakir, Nabeel ; Dugi, Daniel ; Cordon, Billy H. ; Hofer, Matthias D. ; Morey, Allen F. / Permanent Bulbar Urethral Ligation : Emerging Treatment Option for Incontinent Men With End-stage Urethra. In: Urology. 2017 ; Vol. 105. pp. 186-191.
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abstract = "Objective To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra. Materials and Methods From our institutional artificial urinary sphincter database of 512 patients from 2010 to 2016, 10 men underwent permanent urethral ligation with concurrent suprapubic tube diversion following recurrent artificial urinary sphincter cuff erosion. Clinical characteristics and outcomes were evaluated. Quality of life was assessed using the Michigan Incontinence Symptom Index and the Patient Global Index of Improvement. Results Urethral ligation resulted in resolution of incontinence in 8 men (80{\%}), including 7 (70{\%}) after 1 surgery and in 1 (10{\%}) after a single revision. The average American Society of Anesthesiologists physical status rating was 2.7 (range 2-3). Seven patients (70{\%}) experienced postoperative complications (4 Clavien-Dindo grade II complications [1 Clostridium difficile infection, 3 refractory bladder spasms) and 5 grade III complications (2 abscesses, 2 urethrocutaneous fistula, and 1 bladder stone formation]). Overall, satisfactory Michigan Incontinence Symptom Index urinary scores were reported in 8 (80{\%}) men. On the Patient Global Index of Improvement, 6 (60{\%}) men reported improvement in overall condition following surgery. All men (10/10) stated that they would recommend this procedure to others. Conclusion For debilitated men with end-stage urethra and severe refractory stress urinary incontinence, permanent urethral ligation with chronic suprapubic tube drainage can restore continence and improve quality of life without the need for more invasive formal urinary diversion, though with a high risk of complication.",
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N2 - Objective To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra. Materials and Methods From our institutional artificial urinary sphincter database of 512 patients from 2010 to 2016, 10 men underwent permanent urethral ligation with concurrent suprapubic tube diversion following recurrent artificial urinary sphincter cuff erosion. Clinical characteristics and outcomes were evaluated. Quality of life was assessed using the Michigan Incontinence Symptom Index and the Patient Global Index of Improvement. Results Urethral ligation resulted in resolution of incontinence in 8 men (80%), including 7 (70%) after 1 surgery and in 1 (10%) after a single revision. The average American Society of Anesthesiologists physical status rating was 2.7 (range 2-3). Seven patients (70%) experienced postoperative complications (4 Clavien-Dindo grade II complications [1 Clostridium difficile infection, 3 refractory bladder spasms) and 5 grade III complications (2 abscesses, 2 urethrocutaneous fistula, and 1 bladder stone formation]). Overall, satisfactory Michigan Incontinence Symptom Index urinary scores were reported in 8 (80%) men. On the Patient Global Index of Improvement, 6 (60%) men reported improvement in overall condition following surgery. All men (10/10) stated that they would recommend this procedure to others. Conclusion For debilitated men with end-stage urethra and severe refractory stress urinary incontinence, permanent urethral ligation with chronic suprapubic tube drainage can restore continence and improve quality of life without the need for more invasive formal urinary diversion, though with a high risk of complication.

AB - Objective To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra. Materials and Methods From our institutional artificial urinary sphincter database of 512 patients from 2010 to 2016, 10 men underwent permanent urethral ligation with concurrent suprapubic tube diversion following recurrent artificial urinary sphincter cuff erosion. Clinical characteristics and outcomes were evaluated. Quality of life was assessed using the Michigan Incontinence Symptom Index and the Patient Global Index of Improvement. Results Urethral ligation resulted in resolution of incontinence in 8 men (80%), including 7 (70%) after 1 surgery and in 1 (10%) after a single revision. The average American Society of Anesthesiologists physical status rating was 2.7 (range 2-3). Seven patients (70%) experienced postoperative complications (4 Clavien-Dindo grade II complications [1 Clostridium difficile infection, 3 refractory bladder spasms) and 5 grade III complications (2 abscesses, 2 urethrocutaneous fistula, and 1 bladder stone formation]). Overall, satisfactory Michigan Incontinence Symptom Index urinary scores were reported in 8 (80%) men. On the Patient Global Index of Improvement, 6 (60%) men reported improvement in overall condition following surgery. All men (10/10) stated that they would recommend this procedure to others. Conclusion For debilitated men with end-stage urethra and severe refractory stress urinary incontinence, permanent urethral ligation with chronic suprapubic tube drainage can restore continence and improve quality of life without the need for more invasive formal urinary diversion, though with a high risk of complication.

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