Artificial urinary sphincters for male stress urinary incontinence: current perspectives

Abstract

The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.

Development and future prospects of the artificial urinary sphincter

“…In another study of 100 patients receiving Flow Secure implants, 28% had the device removed due to pump perforations and mechanical failures during pressurization. 26 The Pro-ACT is also a hydraulically activated AUS 27 (Figure 3E). In 2005, Gregori A conducted a study on Pro-ACT 28 and analyzed the outcome data of 62 patients.…”

Evaluation of benefits and harms of surgical treatments for post-radical prostatectomy urinary incontinence: a systematic review and meta-analysis protocol

“…Long-term adverse events as defined as the rates of revision (secondary operation) and explantation (removal) of the surgical device 27 , 28 .…”

Survey of Microsurgery Training Availability in US Urology Residency Programs

“…Microscopic varicocelectomy is the gold standard for repair of varicoceles [ 5 ]. For comparison, there are roughly 11,500 artificial urinary sphincters placed globally each year, and over 20,000 penile prostheses placed annually in the US, and there is an ACGME minimum requirement of 10 cases for male incontinence/penile reconstructive (including penile prosthesis and artificial urinary sphincter) procedures [ 6 7 ]. With such high numbers of urologic microsurgical procedures in the US, it appears there is a demand for microsurgery teaching in urology.…”