A systematic review and meta-analysis of clinical and functional outcomes of artificial urinary sphincter implantation in women with stress urinary incontinence

Abstract

Objective: To evaluate the complications and results of artificial urinary sphincter (AUS) implantation in women with stress urinary incontinence (SUI). Methods: A selective database search using keywords (1990-2019) was conducted to validate the effectiveness of the AUS in women. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilised. The meta-analysis included 964 women (15 studies) with persistent SUI. The Newcastle-Ottawa score was used to determine the quality of the evidence in each study. The success rate and complications associated with the AUS were analysed. Results: Meta-analysis of the published studies showed that complete continence was achieved at a mean rate of 79.6% (95% confidence interval [CI] 72.2-86.6%) and a significant improvement was achieved in 15% (95% CI 10-25%). The mean (range) follow-up was 22 (6-204) months. The mean number of patients per study was 68. The mean (range) explantation rate was 13 (0-44)%. Vaginal erosion occurred in a mean (range) of 9 (0-27)% and mechanical complications in 13 (0-47)%. Infections accounted for 7% of the complications. The total mean (range) revision rate of the implanted AUS was 15.42 (0-44)%. The mean (range) size of the cuff used was 6.7 (5-10) cm. Conclusion: Our present analysis showed that implantation of an AUS in women with severe UI is an effective treatment option after failure of first-line therapy. However, the currently available study population is too small to draw firm conclusions.

Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023)

“…The study reported complete continence rates of 61% to 100% at mean follow-up of 5 to 204 months, and the authors concluded that AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. Explantation and mechanical failure rates in this analysis were similar to that reported by Barakat et al, 31 and urethral erosion rate varied from 0% to 22%. This series specifically noted intraoperative bladder neck and vaginal injury rates of 0% to 44% and 0% to 25%, respectively.…”

“…Three recent meta-analyses specifically evaluating non-neurogenic SUI provided insight into the role of the AUS in the treatment of non-index SUI patients. Barakat et al 31 performed a systematic review of 15 studies (n=964) in women with persistent SUI following unspecified anti-incontinence treatments. Success rates and complications supported AUS as an effective treatment in women with severe UI after failure of first-line therapy.…”

The Role of Artificial Urinary Sphincter in Female Incontinence in 2023: A Literature Update

“…[12] It is difficult to make a direct comparison between the studies because of the heterogeneous groups and the fact that most of the studies were retrospective. As a result of this, there is still no evidence supporting the efficiency of the AUS in women who have SUI [13].…”