Device Survival after Primary Implantation of an Artificial Urinary Sphincter for Male Stress Urinary Incontinence

Abstract

These data provide a general overview of artificial urinary sphincter device survival and may serve urologists when counseling patients. Younger age, penoscrotal approach and use of a tandem cuff may be associated with inferior outcomes.

Male urinary incontinence: Artificial sphincter

“…Although there was no difference between the two groups regarding continence rates (83 vs. 80%, NNT = NS), patients with a history of irradiation who underwent 3.5 cm cuff implantation (N = 100) presented a 17% increase in the risk of erosion through the cuff (NNH = 6; 95CI [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] 31 (D) The prosthesis may be filled with isotonic sterile sodium chloride solution or contrast, at the surgeon's discretion. The solution must be isotonic to minimize the transfer of fluid through the semipermeable silicone membrane.…”

“…23 patients with a mean age of 70 were included (age [SD], 60-85 [7]). Of these, 18 patients had urethral atrophy and/ or erosion after AUS placement (11 patients), male sling (four patients) or both (three patients), and five patients had severe urethral atrophy after pelvic radiotherapy.…”

“…6 The standard placement of an AUS involves a small incision made in the patient's perineum or scrotum. Perineal access is considered the most common; 7 however, authors have also described the scrotal technique, thus, the advantages and disadvantages of each should be considered by the surgeon. 8 The "cuff," which is the portion of the device that surrounds and obstructs the urethra, is usually placed directly around the urethra (i.e., the "standard" placement).…”

“…After the analysis of the full texts, eight studies aiming only to describe the surgical technique were included in our evaluation. 7,8,31,[46][47][48][49][50] Series of cases with a small number of patients included (n < 20) and a narrative review were the main reasons for exclusion.…”

Predictors of Device-related Complications After Exchange of the Pressure-regulating Balloon in Men With an Artificial Urinary Sphincter

“…1 Though it remains the most effective therapy for reducing stress-induced urine leak in male patients, the AUS often requires revision surgery. 2,3 Indications for reoperation include recurrent or persistent incontinence, repairing a device that has failed, and explanting a device that has either eroded or become infected. 4 While the literature suggests that a significant number of patients will undergo revision of their device to improve continence, there is no consensus on what the most effective technique is.…”