U J 03 - All-2.pdf 611Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L 1Department of Oncologi- cal and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy 2Department of Envi- ronmental Medicine and Public Health, Section of Legal Medicine and Foren- sic Pathology, University of Padova, Padova, Italy 3Department of Clinical and Experimental Medi- cine, University of Padova, Padova, Italy Rafael Boscolo-Berto,1,2 Daniela I. Raduazzo,3 Giovanni Cecchetto,2 Guido Viel2 Urethral Catheterization in Men With Artificial Urinary Sphincter Clinical and Legal Implications Corresponding Author: Rafael Boscolo-Berto, MD Department of Environ- mental Medicine and Public Health, Institute of Legal Medicine, Univer- sity Hospital of Padova, Via Falloppio 50, 35121, Padova, Italy Tel: +39 049 827 2200 Fax: +39 049 796 9541 E-mail: rafael.boscoloberto @unipd.it Received March 2010 Accepted April 2010 CASE REPORT Keywords: - cal procedures INTRODUCTION Simplanted for the treatment of urinary incontinence in men, mostly in patients affected by post-prostatectomy incontinence.(1) complications. The former are due to a physical failure of the device or to intra-operative errors in rate ranging from 4% to 13%, and may occur also in a late setting.(2,3) The longest time-to-erosion range reported in the literature is of 7 to 10 years after the implantation.(4-6) We report the case of a scrotal extrusion of the pump occurred 22 years after the placement of an - - tions leading to a major surgical intervention. CASE REPORT failure. - 1): a scrotal control-pump, an abdominal pressure-regulating balloon, and an occlusive bulbous- 612 | At the department of emergency, an abdominal ultrasonog- raphy revealed a severe bilateral hydroureteronephrosis The picture attributed to a mechanical defect of the occlu- - After 3 months, the patient complained from the scrotal ex- Surgical removal of the entire device and a perineal urethros- - - surface immediately caudal to the distal margin of the bulbar Figure 1. Artificial urinary sphincter AMS-800™ consisting of 3 components connected by kink-resistant tubing: a scrotal con- trol pump, an abdominal pressure-regulating balloon, and an occlusive bulbous urethra cuff. Note the dotted line showing the normal position of the prostate, in this case previously removed by radical prostatectomy. Figure 2. Evidence of a partially extruded scrotal pump at the physical examination (arrow). Case Report 613Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L Complicated Catheterization of a Patient With AMS-800 | Boscolo-Berto DISCUSSION - - tor for urethral erosion. disease, or pre-operative urodynamics, traumas intended as an activated or malfunctioning device are considered as po- tential causes of urethral lesions, facilitated by the tissutal devascularization due to urethral atrophy.(5,7,9,10) - tion, described in the literature as a potential determinant of urethral erosion, as the cause of the damage localized in the bulbar portion of the urethra. We conceive that the amiss - vated sphincter due to its malfunctioning and that the scro- tal extrusion of the pump, caused by a subsequent urinary opened onto the ventral surface of bulbar urethra, the easiest of a perineal urethrostomy. a complication presented as a consequence of an improper invasive maneuver occurred 22 years after the implantation CONCLUSION - led to a major surgical intervention. We do believe that in a because of its possible malfunction or the presence of ure- thral atrophy associated to tissutal devascularization, a tem- porary suprapubic cystostomy by ultrasound guidance avoid- ing damage to the AMS components may be advised in place of a urethral stressful catheterization to avoid further com- approach is subtended to a clinical rational, and may avoid malpractice litigations accounting for a medical liability. CONFLICT OF INTEREST None declared. REFERENCES 1. Reynolds WS, Patel R, Msezane L, Lucioni A, Rapp DE, Bales GT. Current use of artificial urinary sphincters in the united states. J Urol. 2007;178:578-83. 2. Gousse AE, Madjar S, Lambert MM, Fishman IJ. Artificial uri- nary sphincter for post-radical prostatectomy urinary incon- tinence: Long-term subjective results. J Urol. 2001;166:1755- 8. 3. Elliott DS, Barrett DM. Mayo clinic long-term analysis of the functional durability of the ams 800 artificial urinary sphinc- ter: A review of 323 cases. 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Post-operative risk factors associated with artificial urinary sphincter infection-erosion. Br J Urol. 1995;75:354-8. 10. Kowalczyk JJ, Spicer DL, Mulcahy JJ. Long-term experience with the double-cuff ams 800 artificial urinary sphincter. Urology. 1996;47:895-7.