Im Zeitraum von 1999 bis 2009 wurde am Universitätsklinikum Göttingen bei 65 Patienten im Rahmen einer Harninkontinenztherapie ein operativer Eingriff mit einem künstlichen Sphinktersystem durchgeführt. Die vorliegende Arbeit untersucht den Erfolg dieser Behandlungsmethode. Dazu wurden sowohl präoperative Befunde aus den Patientenakten erhoben als auch der postoperative Verlauf bewertet. Mit Hilfe zweier validierter Fragebögen sowie selbst formulierter Zusatzfragen, die sich mit der allgemeinen Lebensqualität der behandelten Patienten, mit der Inkontinenzsymptomatik und der die Miktion betreffenden Lebensqualität beschäftigen, sollen sowohl die subjektive Patientenzufriedenheit als auch Veränderungen bezüglich der präoperativen und postoperativen Kontinenzsituation der Betroffenen evaluiert werden. Die Schwerpunkte der Auswertung betreffen die postoperative Kontinenzsituation, die Komplikationsrate und die Zufriedenheit der Patienten mit dem Behandlungserfolg. Die Ergebnisse werden mit bereits veröffentlichten Literaturangaben verglichen und diskutiert.

Artificial urinary sphincters have been used for decades for treatment of urinary incontinence. A commonly used device, the AMS 800 consists of a urethral cuff, pump and an abdominal reservoir. Notable complications of this system include scrotal or labial hematomas, infection or erosion of the cuff and rarely migration of its components. Although there are few reported cases related to effects from pump migration, those documenting reservoir related complications are even rarer. We present a case of reservoir migration adjacent to the ascending colon causing ischemic changes mimicking colonic neoplasm. Our patient, a 66-year old male with medical history of adenocarcinoma of prostate status post radical prostatectomy, had been having abdominal pain for a month. A CT scan showed cecal and proximal ascending colonic irregular nodular thickening suggestive of colonic mass. It also revealed a low-density structure next to the ascending colon abutting into area of the mass. A follow up colonoscopy showed a fungating, ulcerated mass extending from cecum to ascending colon concerning for a malignancy of which biopsy was also done. The patient then underwent right open hemicolectomy. During surgery, a balloon reservoir was seen in the abdominal cavity with its adherence to the right colon but not eroding into it. The surgeon dissected the balloon, repositioned and re-peritonealized it before closing the abdomen. The colonoscopic and surgical pathology instead demonstrated findings of ischemic colitis with mucosal ulceration in cecum and ascending colon limited to the mucosa but no evidence of cancer. Retrospective chart review revealed history of artificial urinary sphincter implantation for urinary incontinence related to radical prostatectomy for adenocarcinoma eight years prior. With manufacturer suggested implant location of the reservoir in prevesical space, the possibility of migration needs to be accounted for. Although there are not many reports of artificial sphincter reservoir related complications, there are cases documenting inflatable penile prosthesis reservoir erosion into abdominal and pelvic structures. As the CT scan demonstrated reservoir indentation into the ascending colon, it likely led to chronic irritation of the adjacent colonic wall due to mass effect. It is hypothesized that constant pressure on colonic wall likely led to localized ischemia. This resulted in localized inflammation including submucosal edema, which can create a mass-like appearance when severe. This case emphasizes that, while preliminary radiographic imaging and even gross colonoscopy findings may be suggestive of a malignancy, it is imperative to await biopsy results to confirm the diagnosis of a malignant neoplasm. Our case report emphasizes the consideration of diagnoses other than colon cancer when faced with a colonic mass especially in the setting of implanted intra-abdominal foreign body to avoid unnecessary surgery and related complications.

La société UroMems propose de résoudre les problèmes d’incontinence urinaire avec un nouveau sphincter urinaire artificiel, dans lequel le mécanisme de pompe manuelle utilisé dans les sphincters actuellement implantés dans de nombreux patients est remplacé par un dispositif mécatronique. Une manchette occlusive, mimant le fonctionnement du sphincter naturel, est reliée et activée par le dispositif afin d’autoriser la miction et l’incontinence du patient.Le travail de thèse s’oriente sur la compréhension et l’amélioration du sphincter artificiel. La première partie de cette étude porte sur la numérisation et la modélisation 3D de cette manchette, la caractérisation mécanique de ses différents composants et la mise en place d’un modèle éléments finis. Un banc de test sur un cas simple avec suivi par stéréo-corrélation d’images est également présenté afin de valider le comportement du modèle numérique pour un chargement simple. La deuxième partie porte sur la simulation du geste chirurgical et du fonctionnement de la manchette ainsi qu’une validation du modèle éléments finis en comparaison avec des mesures effectuées sur paillasse. La troisième partie de ce travail consiste à produire des données expérimentales sur sujet anatomique afin d’observer le fonctionnement de la manchette dans son environnement naturel. Les résultats de cette étude ont motivé l’utilisation d’un matériau fantôme (un hydrogel de Polyvinyl alcohol) dont les propriétés mécaniques sont ajustables. Une caractérisation mécanique de cet hydrogel est présentée ainsi qu’un banc d’essai servant de cas test pour la validation du modèle numérique complet. La quatrième partie propose une analyse histo-morphologique de l’urètre masculin, ainsi qu’une caractérisation mécanique complète. Les données obtenues sont ensuite intégrées au modèle éléments finis afin de simuler le fonctionnement de la manchette occlusive dans son environnement naturel. Dans la dernière partie l’outil numérique mis en place est exploité afin de proposer des pistes d’améliorations du sphincter artificiel actuel. / UroMems aims at developing a novel treatment solution for severe urinary incontinence by replacing the manual pump mechanism, which is currently considered as the gold standard and which is implanted in patients throughout the world, by a mechatronic device. An occlusive cuff that mimics the natural human sphincter is linked to the device in order to ensure continence and allow micturition.This work focuses on understanding and improving the artificial sphincter. The first part of this study aims at modeling of the occlusive cuff, characterizing the mechanical behavior of all of its components and establishing a corresponding finite element model. A bench test using digital image correlation is also presented in order to validate the behavior of the numerical model for a simple test. In the second part the implantation of the occlusive and its inflation are simulated and the model is validated by comparing its results to the data measured experimentally. The third part aims at validating the interaction between the occlusive cuff and an extraneous body in the numerical simulation. To this end the in vivo experimental behavior of the occlusive cuff is observed. The variability measured among the different subjects motivated the use of a phantom material (a Polyvinyl alcohol hydrogel) of controlled mechanical properties. A thorough mechanical characterization of the hydrogel is also presented in this part as well as a test bench used for the validation of the numerical model. The fourth part proposes a histo-morphological analysis of the male urethra and its mechanical characterization. The data obtained were then integrated to the finite element model. The last part of this work is dedicated to exploiting the finite element tool to propose design improvement of the occlusive cuff.

(1) Background: This study examined outcomes of second-line ATOMS implantation after failure of the fixed male sling (FMS) AdVance/AdVance XP. (2) Methods: A retrospective multicenter cohort analysis was carried out in men implanted with an ATOMS between 2011 and 2020 after failure of an AdVance/AdVance XP. Success was assessed on the basis of objective (dryness, 0–1 pad/24 h or >20 g/24 h pad test) and subjective results (PGI-I). We performed the Wilcoxon rank sum test, Fisher’s exact test, logistic regression, and multivariate analysis. (3) Results: The study included 88 patients from 9 centers with a mean age of 71.3 years. No Clavien–Dindo > II complications occurred within the first 3 months after ATOMS implantation. A total of 10 cases (9%) required revision in the ensuing clinical course. After a mean follow-up of 42.5 months, 76.1% achieved social continence, and 56.8% used no pads at all. Mean urine leakage/24 h dropped from 422 g (3.9 pads) to 38 g (0.69 pads) and the mean ICIQ-SF decreased from 16.25 to 5.3 (p < 0.0001). PROMs (patient-reported outcome measures) showed improvement in 98.9% of cases, and 63.6% gave a “very much better” PGI-I rating. Multivariate analysis identified a lower probability of achieving maximum satisfaction for the following factors: the AdVance XP as first-line therapy (OR 0.35), a lower ICIQ-SF question 1 (OR 0.26), status post-irradiation (OR 0.14), and more severe pain prior to ATOMS implantation (OR 0.51). (4) Conclusions: Implantation of an ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP sling. High patient satisfaction was demonstrated in a long-term follow-up.