Artificial urinary sphincter for post‐prostatectomy incontinence: A review

Abstract

Abstract:The artificial urinary sphincter remains the gold standard for treatment of postprostatectomy urinary incontinence. The AMS 800 (American Medical Systems, Minnetonka, MN, USA) is the most commonly implanted artificial urinary sphincter. Having been on the market for almost 40 years, there is an abundance of literature regarding its use, but no recent review has been published. We reviewed the current literature regarding the indications, surgical principles, outcomes and complications of artificial urinary sphincter implantation for stress urinary incontinence after prostatectomy. A PubMed search was carried out for articles on the artificial urinary sphincter from 1995 to present. The review was centered on articles related to the use of the AMS 800 for stress urinary incontinence in males after prostatectomy. Relevant articles were reviewed. The majority of patients will achieve social continence (1 pad per day) after artificial urinary sphincter implantation; however, rates of total continence (no pad usage) are significantly lower. Patient satisfaction outcomes average greater than 80% in most series. Potential complications requiring reoperation include infection (0.5-10.6%) and urethral erosion (2.9-12%). Revision surgeries are most commonly as a result of urethral atrophy, which ranges from 1.6 to 11.4%. The 5-year Kaplan-Meier freedom from reoperation ranges from 50 to 79%, while the 10-year Kaplan-Meier freedom from mechanical failure is 64%. The artificial urinary sphincter is a reliable device with good outcomes. As expected with any prosthetic device, complications including mechanical failure, infection, erosion and recurrent incontinence remain significant concerns. Despite known complications, the patient satisfaction rates after artificial urinary sphincter implantation remain high. Appropriate patient counseling and adherence to surgical principles are imperative.

Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

“…A literature review noted complication rates and continence outcomes were not affected by previous radiation. 5 Thus it is reasonable to conclude that the increased incidence of radiation in the AUS group, though making it more technically challenging, may not significantly affect our comparison.…”

“…James and McCammon reviewed 9 studies and found an infection rate of 0.5% to 10.6%, comparable to the 4.2% infection rate in this study. 5 The introduction of an antibiotic InhibiZone coating to the AUS was intended to decrease the infection rate. However, a study retrospectively comparing 426 patients evenly treated with and without InhibiZone coated AUS found no difference in infection rates, but a significantly increased cost associated with the coating (about $1300/ device).…”

“…22 Re-operation represents a severe potential consequence of the AUS and rates range from 5% to 61%. 5 The most common indications for revision include erosion, infection, mechanical dysfunction or worsening incontinence.…”

“…4 It is still considered the current gold standard for the management of PPI with excellent long-term 5-year continence rates. 5 In 2006, the AdVance transobturator male sling was introduced as a minimally invasive alternative to the AUS (AMS, Minnetonka, MN). 6 Mild to moderate PPI management presents a dilemma.…”

Multicentre Experience with ZSI 375 Artificial Urinary Sphincter for the Treatment of Stress Urinary Incontinence in Men

“…ZSI 375 previous series outcomes have shown excellent short-term results, which ranged from 87 to 94.2% (15)(16)(17). Regarding the AMS 800 numerous studies, disparate continence rate are presented from total continence ≤ 90% (4,5,(18)(19)(20) to 73% of patients dry or substantially dry and 88% showing improvement (21). Our social continence rate and success rate of the 12, 24 and 36 months follow-up period meet AMS 800 performances.…”