Revision Techniques After Artificial Urinary Sphincter Failure in Men: Results From a Multicenter Study

Eswara, Jairam R.; Chan, Robert; Vetter, Joel; Lai, H. Henry; Boone, Timothy B.; Brandes, Steven B.

doi:10.1016/j.urology.2015.04.023

Cited by 34 publications

(19 citation statements)

References 23 publications

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“…We also examined the success of single-component AUS revision in the setting of device failure without suspicion of erosion or infection. While the literature on AUS revision has demonstrated reasonable outcomes after secondary surgery, the approach and technique for revision vary [8,14]. Current recommendations suggest entire device exchange in patients with recurrent incontinence after 3 yr [15].…”

Section: Discussionmentioning

confidence: 99%

Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival

Srivastava

Joice

Patel

et al. 2019

European Urology Focus

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Section: Discussionmentioning

confidence: 99%

Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival

Srivastava

Joice

Patel

et al. 2019

European Urology Focus

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“…Eswara et al 11 described revision techniques after AUS failure in men. However, these techniques were not robot-assisted procedures, the patients included underwent not only abdominal but overall perineal approach, and finally the failure was most of the time a recurrence of urinary incontinence, with no immediate failure as described in this case report.…”

Section: Discussionmentioning

confidence: 99%

Persistent urinary incontinence after a robot-assisted artificial urinary sphincter procedure: lessons learnt from two cases

et al. 2016

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This case report describes 2 cases of persistent urinary incontinence in the beginning of the learning curve of robot-assisted bladder neck implantation of an artificial urinary sphincter (RA-AUS) in men at risk for erosion due to neurological lesions. Among a series of 4 RA-AUS, 2 patients still experienced urinary incontinence after surgery. A complete urological workup was strictly normal and did not show any device malfunction. However, during an AUS revision in these two patients, exploration revealed that the cuff was not tight enough. This issue was resolved by placing smaller cuffs. After re-do surgery, one of the two patients no longer had urinary incontinence, while the second patient was lost to follow-up. Insufficient tightness of the cuff could be explained by an inability of the surgeon to feel the force while pulling the cuff around the urethra due to the absence of haptic sensation in robotic surgery.

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“…Higher rates of mechanical failure were noted in a series of revisions where patients did not have complete replacements but merely had their cuffs downsized. 48 Some have suggested that performing partial replacements of an AUS can lead to higher failure/leakage rates secondary to biofilm that builds on the in situ components if one uses the accessory quick connect kit rather than suture tie the connections. 49 …”

Section: Complicationsmentioning

confidence: 99%

“…In the largest multi-institutional series of revisions, the mean time to revision was 28.9 months. 48 Additionally, patient satisfaction has been shown to be independent of the number of revisions, and studies have shown that up to 90% of patients undergoing revision had no change in satisfaction as long as they had a functional AUS. 24 – 26 …”

Section: Revisionsmentioning

confidence: 99%

Artificial urinary sphincters for male stress urinary incontinence: current perspectives

Cordon¹,

Singla²,

Singla³

2016

MDER

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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.

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Revision Techniques After Artificial Urinary Sphincter Failure in Men: Results From a Multicenter Study

Cited by 34 publications

References 23 publications

Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival

Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival

Persistent urinary incontinence after a robot-assisted artificial urinary sphincter procedure: lessons learnt from two cases

Artificial urinary sphincters for male stress urinary incontinence: current perspectives

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