Long-term Outcomes After Primary Failures of Artificial Urinary Sphincter Implantation

Diagnostic challenges in the evaluation of persistent or recurrent urinary incontinence after artificial urinary sphincter (AUS) implantation in patients after prostatectomy

“…As discussed in the previous section, most cuff erosions usually occur around 3-6 months after implantation and invariably results in prosthesis infection [7]. Later causes of erosion are frequently related to urinary catheterisation with a non-deflated cuff, but erosion may also occur from excessive cuff-urethral pressure necrosis.…”

“…In fact, tissue atrophy is probably the most common cause of non-mechanical failure and also the most common cause for AUS revision [4,7,9]. Since 1987, the incidence of tissue atrophy has decreased considerably with the introduction of a narrow-backed cuff [2,3].…”

“…Later causes of erosion are frequently related to urinary catheterisation with a non-deflated cuff, but erosion may also occur from excessive cuff-urethral pressure necrosis. The risk factors for cuff erosion include pelvic radiation, excessive cuff pressure, undersized cuff, and retrograde instrumentation without deactivating the AUS device properly [5,7]. A history of recent instrumentation, e.g.…”

“…Presently, there is an abundance of literature on patient selection, surgical techniques and clinical outcomes in AUS implantation [3][4][5][6][7]. However, there is a lack of information pertaining to the postoperative evaluation and management in patients with AUS implant who complain and continue to have UI.…”

“…1) There are many causes of persistent and/or recurrent UI and these can sometimes overlap. The potential causes include improper and/or accidental operation of the pump control unit, UTI with detrusor overactivity, de novo overactive bladder, urethral cuff atrophy, urethral cuff erosion, improper cuff size and PRB unit, development (recurrence) of urethral or bladder neck stricture, as well as device malfunctions from fluid loss and occlusion of the control unit [7][8][9]. Fortunately, a careful history and thorough clinical evaluation can often reveal the problem.…”