Urethral pressure profile assessment after artificial urinary sphincter implantation (FlowSecure^™ and AMS-800^™): A case series

Abstract

The AMS-800 ™ artificial urinary sphincter has become the ‘gold standard’ in the treatment of male stress urinary incontinence. In 2006, the novel artificial urinary sphincter FlowSecure ™ containing a stress relief balloon providing low cuff pressures at rest with conditional pressure elevation during periods of stress has been launched. We assessed the intraurethral pressure in the cuff area of the AMS-800 and the FlowSecure by urethral pressure profile in four patients each. Urethral pressure profile was performed at rest and during coughing. In addition, continence situation and patient satisfaction after artificial urinary sphincter implantation was assessed. At rest, median pressure in the cuff region was 74 (38–117, FlowSecure) cm H 2 O and 102 (95–110, AMS-800) cm H 2 O. During coughing, pressure peaks rose to 135 (54–162, FlowSecure) cm H 2 O and 202 (128–216, AMS-800) cm H 2 O. Median pad usage before artificial urinary sphincter implantation in the FlowSecure and the AMS-800 group was 4 (3–4) and 4.5 (2–6) pads/24 h, respectively. At the time of urodynamic investigation, median pad usage declined to 1.5 (0–4) pads/24 h in the FlowSecure and to 1 (1–2) pads/24 h in the AMS-800 group. Seven of eight patients reported on a satisfactory quality of life, and one patient remained unhappy after FlowSecure implantation. It remains unclear if the trade-off in favour of lower cuff pressures, and consecutively lower intraurethral pressures, holds truly long-term benefits regarding device revision, explantation and patient satisfaction.