Management of male incontinence following artificial urinary sphincter failure

Abstract

We believe that continence can be salvaged in the majority of men in whom the device fails or requires explantation and we present the logical analysis for device revision and relocation in this review.

Male urinary incontinence: Artificial sphincter

“…There are several causes of persistent and/ or recurrent UI: unsuitable or accidental pump operation, urinary tract infection (UTI) with detrusor overactivity, overactive bladder, urethral atrophy, urethral erosion of the cuff, inadequate cuff size, insufficient pressure of the reservoir balloon, development (recurrence) of urethral or bladder neck stenosis, as well as device failure with fluid loss or obstruction of the control unit flow. 12,14,15 Revision rates between 8 and 45% have been reported due to mechanical failure, while those derived from nonmechanical complications such as erosion, urethral atrophy and infections are reported between 7 and 17%. 1,[16][17][18] Certain complications have been described, with the most significant being erosion and/or extrusion of the sphincter, infection and urethral atrophy.…”

Diagnostic challenges in the evaluation of persistent or recurrent urinary incontinence after artificial urinary sphincter (AUS) implantation in patients after prostatectomy

“…Inadequate cuff deflation and/or inadvertent activation of the locking mechanism can lead to incomplete bladder emptying and subsequent overflow incontinence. Fortunately, failure of the sphincteric cuff to inflate and deflate on activation of AUS device in the early postoperative period is extremely rare [2,3,8,9]. A poorly placed control pump in the scrotum can be accidentally compressed and cause unintentional cuff deflation and UI.…”

“…In fact, tissue atrophy is probably the most common cause of non-mechanical failure and also the most common cause for AUS revision [4,7,9]. Since 1987, the incidence of tissue atrophy has decreased considerably with the introduction of a narrow-backed cuff [2,3].…”

“…1) There are many causes of persistent and/or recurrent UI and these can sometimes overlap. The potential causes include improper and/or accidental operation of the pump control unit, UTI with detrusor overactivity, de novo overactive bladder, urethral cuff atrophy, urethral cuff erosion, improper cuff size and PRB unit, development (recurrence) of urethral or bladder neck stricture, as well as device malfunctions from fluid loss and occlusion of the control unit [7][8][9]. Fortunately, a careful history and thorough clinical evaluation can often reveal the problem.…”

Treatment of Post-Prostatic Surgery Stress Urinary Incontinence

“…Any problems would be reversed, in most cases, for simple or surgical outpatient review, which would ensure good continence rates, according to the criteria of effectiveness adopted by different authors (Hussain et al 2005;Mundy, 1991;Vilar et al 2004;Webster & Sherman, 2005).…”