Current Use of the Artificial Urinary Sphincter in Adult Females

Abstract

Purpose of Review The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. Recent Findings While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous antiincontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50 years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. Summary While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.

Comparison of urethral sling surgery and non-ablative vaginal Erbium:YAG laser treatment in 327 patients with stress urinary incontinence: a case-matching analysis

“…Better quality studies are needed to document the exact mechanism of action, longevity, safety, and its eventual place in the current treatment protocols of SUI and OAB. Artificial urinary sphincter (AUS) in female SUI has been reported for decades, but due to its challenging implantation and inherent morbidity, in most countries it was not in use [ 40 ]. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes.…”

Neurological sphincter deficiency: is there a place for artificial urinary sphincter?

“…As previously described, Cox regression analysis in 65 male spina bifida patients demonstrated ISC to be the only significant predictive factor for AUS survival [ 8 ]. This possible drawback for the use of AUS in the N-SUI population is backed up in a recent review report [ 31 ]. However, Gasmi et al, assessed predictors for reoperation- and explantation-free survival in 23 females with spina bifida, 69.6% of which had the need for ICS.…”

Húgycső alatti feszülésmentes szalagműtétek szerepe a nem komplikált női terheléses inkontinentia kezelésében Roles of mid-urethral sling procedures in the management of uncomplicated female stress urinary incontinence

“…A terápiás alternatívákkal (Burch colposuspensio, autológ fascia szalag, submuscosus injekciós kezelések, műsphincter) szembeni előnyük, hogy összevethető vagy jobb eredményességük mellett minimálinvazívak, szövődményarányuk kedvezőbb, amelyet a témába vágó robosztus irodalom erős evidenciái támasztanak alá. Ezen ismeret birtokában az Európai Urológus Társaság 2017-ben, a szintetikus graftokkal szembeni bizalmatlanság érájában konszenzusnyilatkozatot adott ki a MUS-műtétek biztonságos alkalmazhatóságáról (7,(25)(26)(27)(28).…”