A New Operation for Insertion of the Artificial Urinary Sphincter

Abstract

A new operation for implantation of the artificial urinary sphincter for total urinary incontinence in women is described. The procedure is done through the vestibule of the vagina with clear exposure of the vesical neck and urethra anteriorly, and easier accessibility for dissection of the vagina from the posterior wall of the vesical neck and upper urethra. This approach reduces the incidence of occlusive cuff erosion and eliminates the chance of shifting of the device. The model AS 800 artificial sphincter was implanted for the first time in 4 patients with total urinary incontinence. Primary deactivation was used and the patients practiced nocturnal deactivation. Complete post-activation continence was achieved in all 4 patients. Mean followup has been 14 months. This approach is easier and less traumatic to the patient. Hospitalization and postoperative recovery times are markedly reduced. Technically, the method is much simpler to perform, particularly dissection between the vagina and the posterior aspect of the urethra, thereby reducing the operative time and complication rate.

Artificial urinary sphincter (AMS 800) implantation for women with intrinsic sphincter deficiency: a technique for insiders?

“…The implantation of the AUS can be performed using one of two approaches: the retropubic [13] or the transvaginal (Abbassian’s route [26]) approach. The transvaginal route is associated with a relatively high morbidity and infection rate [17,27].…”

A Review of the Complications and Results of Implantation of the AMS Artificial Urinary Sphincter

“…The world literature appears to include reports on 2,606 patients implanted with the AMS 800 [41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82]. The literature also includes anecdotal reports of its usage in patients with renal transplantation [58], pregnancy [60, 79]and overoptimistic reports [51]of implantation in conjunction with penile implants [51, 72].…”

“…It can be activated for the first time by percutaneous manipulation [48, 54, 68]several weeks post-implantation. In order to further reduce the chance of ischaemia, the device may be kept deactivated during the night [47, 48]. …”

AMS‐800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review

“…Despite this, vaginal AUS implantation in female patients has been largely abandoned for many years . No series reporting vaginal AUS implantation has been published since these two preliminary articles from the 1980s . One possible explanation for this discrepancy between these encouraging reports and the scarce use of the vaginal approach would be the high likelihood of a publication bias, with possibly unpublished poor outcomes having prompted the urologic community to forego this approach.…”