Newer and novel artificial urinary sphincters (AUS): the development of alternatives to the current AUS device

Abstract

Introduction• The current artifi cial urinary sphincter ( AUS ), AMS 800™ ( A merican M edical S ystems, M innesota, MN , USA ) is considered the standard of care for the treatment of urinary incontinence ( UI ).• While the long-term effectiveness, safety, and durability of the current model of the AMS 800 are well documented, it is not without its limitations and complications. Over the last few years, improvements in design and innovative research into AUS devices have increased the treatment arsenal in male UI . Methods• Articles from peer-reviewed journals, abstracts from scientifi c meetings and electronic literature searches formed the basis of this review. Results• Newer AUS models, e.g. F low S ecure™, Z ephyr™, P ro-ACT ™ and other novel experimental AUS devices, are designed to simulate a healthy human sphincter and address the limitation of the existing AMS 800 device. Conclusions• Newer and novel AUS models are innovative and showed promising outcomes in short-to intermediate-term follow-up.• However, there exists the need for prospective randomised clinical trials and complete reporting of adverse and long-term results before these AUS models can replace the existing AMS 800 device. Keywordsartifi cial urinary sphincter ( AUS ) , urinary incontinence , sphincter device , mechanism of action , innovative design Newer and novel artifi cial urinary sphincters ( AUS ): the development of alternatives to the current AUS device

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

“…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]. Tissue atrophy results in loss of urethral compression and luminal occlusion.…”

“…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.…”

“…Potential sources of fluid loss include the inflatable cuff, disruption in tubing and tubing connections, leak in PRB or control-pump unit, while those with control-pump malfunction are kinking in the tubing or occlusion of the control assembly from particulate matter. The introduction of a fluoro-silicone layer between the two cuff leaflets and kink-resistant tubing has minimised the majority of the fluid leaks [2,3]. However, disruption near the tubing connections remains an issue.…”

“…This ingenious device consists of three components; a control pump, an inflatable cuff, and a pressure-regulating balloon (PRB), which serves dual functions, both as a pressure regulator and also as a fluid reservoir. While the long-term effectiveness, safety, and durability of the current model of the AMS 800 are well documented, it is not without its limitations and complications [2].…”

“…The artificial urinary sphincter (AUS) is considered by many to be the standard of care for men with severe UI and/or post-prostate cancer radiotherapy-related UI [2]. The hydraulically controlled AMS 800 TM (American Medical Systems, Minnetonka, MN, USA) is the most commercially successful and effective AUS device on the market.…”