The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 year actuarial adequate function rates

Abstract

Objective To determine the success (as both continence and revision rates) of the artificial urinary sphincter (AUS) in men incontinent after radical prostatectomy, and thus improve the preoperative counselling provided for these patients. Patients and methods The AUS was implanted in 27 men incontinent after radical prostatectomy (mean age 69 years, range 59–75) at a mean (range) interval of 20 (4–60) months after surgery. The Kaplan–Meier method of survival analysis was used to determine the ‘primary adequate function’ (PAF) rate and the ‘additional procedure‐assisted adequate function’ (APA‐AF) rate. Adequate function was defined as satisfactory continence (use of at most one pad per 24 h) in combination with good AUS function. PAF was defined when no revisions of the AUS were required and APA‐AF when one or more revisions of one or more parts of the AUS were required; a complete exchange or explantation of the AUS defined failure, i.e. the end of APA‐AF. Results At a mean follow‐up of 35 months, 81% of the patients had achieved satisfactory continence. However, the 5 year PAF and APA‐AF rates, based on the Kaplan–Meier curves, were 49% and 71%, respectively. Conclusions Implantation of an AUS can provide excellent continence rates in patients incontinent after radical prostatectomy, but only at the expense of a considerable re‐operation rate. The outcome is best represented by Kaplan–Meier curves of the PAF and the APA‐AF.

The artificial urinary sphincter is the treatment of choice for post–radical prostatectomy incontinence

“…Success rates for AUS as defined by a continence status of 0 to 1 pads per day range from 59% to 90%, 6,7 as shown in Table 1. 2,6,[8][9][10][11][12][13][14][15][16][17] Just as with reported rates of incontinence following prostate cancer surgery depend on the definition of incontinence, continence rates with the AUS can vary with the definition of continence, the method of evaluation and the length of follow-up. The lowest rates are from patient-administered questionnaires.…”

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

“…4 Although the durability of the AUS has been well documented, replacement and revision has been reported in 12%-54% of patients. [5][6][7][8][9][10][11][12] Several techniques have been described for AUS revision due to urethral atrophy and continued incontinence secondary to nonmechanical failure. These include cuff downsizing, cuff relocation, transcorporal cuff placement, and tandem cuff placement.…”

Artificial Urinary Sphincter: Report of the 2015 Consensus Conference

“…The extent and invasiveness of surgeries depend on the need for dissection of new component sites and the number of components manipulated or replaced. Hardly any references suggest adjustment of the deactivation period, depending on technical difficulty of the operative procedure and the resultant scrotal swelling and edema . Revisions that do not involve dissection for a new cuff location and/or do not disturb the pump are unlikely to cause any discomfort.…”