Journal List > Korean J Urol > v.49(6) > 1005127

Oh, Lee, Jung, Yim, and Mah: Twenty Years of Experience with Artificial Urinary Sphincter Implantation

Abstract

Purpose

The efficacy of the artificial urinary sphincter (AUS) in treating sphincteric incontinence has been clearly demonstrated. We report on 20 years of experience using artificial sphincter implantation at a single institute.

Materials and Methods

The follow-up data for 37 patients who received AUS (AMS 800TM) implantation between 1987 and 2006 at Yonsei University were available for this study. We investigated various components of the medical records, such as the number of pads used per day, results of pre-operative urodynamic studies, operative and post-operative complications, and revision rate.

Results

Mean patient age was 35.6 years (range 15-64 years), and mean follow-up duration was 12.4 years (range 1.4-19.8 years). Of the 37 patients, 21 had neurogenic bladder, and 9 had traumatic injury. Other causes of incontinence included post-operative complications (4 patients) and congenital anomalies (3 patients). The cuffs were placed were in the bladder necks of 21 patients and in the bulbous urethrae of 16 patients. The average number of pads used daily decreased significantly from 6.2 to 1.2 after the operation, and 27 patients (72.9%) were able to maintain ‘dry-up status’ (number of pads used≤1). A total of 32 artificial sphincters remained in place (86.4% survival rate), with 8 revisions (21.6%) required secondary to infection, mechanical failure, or urethral stone.

Conclusions

AUS implantation is a safe and durable treatment for urinary incontinence in patients with intrinsic sphincter deficiency from various underlying diseases.

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Table 1.
Patient demographics
No. of patients 37
Mean age 35.6 (15-64)
Male/female 37 / 0 (all male)
Bulbar urethral/bladder neck cuff cm cuff size 16 / 21
  Urethra / B.N
 4.0-5.0 14 / 0
 6.0-7.0 2 / 8
 7.5 0 / 6
 9.0 0 / 3
 11.0 0 / 4
Pressure regulating balloon (cmH2O)
 51-60 13 / 0
 61-70 3 / 15
 71-80 0 / 6

B.N: bladder neck

Table 2.
Surgical outcomes
Pre-op. pad use (No. of pad use/day) 6.2
Post-op. pad use (No. of pad use/day)
Mean 1.2
0 12 patients (32.4%)
1 15 patients (40.5%)
2-3 5 patients (13.5%)
3-4 3 patients (8.1%)
≥5 2 patients (5.4%)
No. of ‘dry-up’ patients (≤1 pad/day) 27 patients (72.9%)
Table 3.
AUS-related complications
Revision (%) 8 (21.6%)
Erosion (cuff) 3
Erosion (pump) 1
Infection 1
Mechanical failure 2
Recurrent incontinece 1
Removal 5 (13.5%)

AUS: artificial urinary sphincter

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