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Transcorporal Cuff-placement in Artificial Urinary Sphincter Surgery: A Systematic Review
Ana Domínguez Gutiérrez1, Manuel Hevia Palacios1, David Alonso López Curtis1
1Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain.
Objective:
To review the literature on survival and functional outcomes of the TC AUS.
Methods:
A systematic review and meta-analysis (PROSPERO: CRD42023393256) was conducted searching the Medline and Embase databases until January 2024. Risk of bias was assessed with ROBINS-I for comparative non-randomized studies and the tool proposed by the EAU for single-arm studies.
Results:
Of 252 screened studies, 20 met the inclusion criteria (8 comparative and 12 non-comparative). Meta-analysis of comparative studies showed a significantly higher revision rate in TC AUS (OR 2.99, 95% CI 1.16-7.75), with no significant difference in explantation (OR 1.41, 95% CI 0.27-7.24). Continence and QoL outcomes appeared comparable between both approaches. Notably, the TC AUS was associated with a significantly lower infection (OR 0.33, 95% CI 0.12-0.95) and erosion rates (OR 0.35, 95% CI 0.15-0.81). Subgroup analysis in the high-risk urethra population demonstrated similar trends.
Conclusion:
TC AUS shows higher revision rates both in the general and high-risk populations. However, these rates are not associated with a higher explantation, which suggests that the TC may be a viable option in complex situations. Additionally, no greater erosion has been observed, even in patients with risk factors.
