Seguimiento del esfínter urinario artificial FlowSecure

Abstract

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the FlowSecure artificial sphincter. The FlowSecure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the FlowSecure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence.

New Artificial Urinary Sphincter Devices in the Treatment of Male Iatrogenic Incontinence

“…Plain X-rays cannot therefore be used for monitoring, and ultrasound scan is the adequate radiographic technique for evaluation. Except verifying prosthesis status, ultrasound also allows measuring of the postvoid residual volume and calculation of the urethral closing pressure [8]. Moreover, MRI can ensure the precise position and integrity of all components of the sphincter [9].…”

“…It is not advisable, during subsequent pressurization, to add more than 2 mL of saline per session [9]. Proper device function must be monitored by free uroflowmetry, ultrasound scan, and clinical history [8]. …”

“…Its main purpose is to achieve total patient continence during periods of raised abdominal pressure while subjecting urethra to the lowest possible pressure during resting. Urethral ischemia potentially leading to atrophy and erosion is thus prevented [8]. Use of one-piece prosthesis also decreases the risk of infection due to intraoperative handling and minimizes the chance of mechanical failure derived from errors during assembly [13].…”