Successful Outcome of Artificial Urinary Sphincters in Men with Post-Prostatectomy Urinary Incontinence Despite Adverse Implantation Features

Abstract

A total of 75 men with post-prostatectomy urinary incontinence underwent artificial urinary sphincter implantation with a mean followup of 3.7 years. Average patient age at implantation was 67 years, with 30 men being 70 years old or older. In only 15 men (20%) was there no adverse implantation feature, while the remainder had adverse features, such as detrusor hyperactivity (44), bladder neck or urethral stricture disease (27), previous radiation therapy (11) and metastatic prostate cancer (11). Although men with ideal implantation characteristics, men with normal detrusors and men who underwent prostatectomy for benign disease had slightly better outcome in terms of urinary continence, in general each group of men with and without adverse features had satisfactory urinary continence. Other than men with a benign prostate, who fared better, each group of men with and without adverse features had equal need for device revisions. In conclusion, men with post-prostatectomy urinary incontinence should not be excluded from consideration for artificial urinary sphincter implantation based on the failure to meet ideal implantation criteria provided such adverse features are recognized and appropriately addressed.

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.…”

Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy

“…Some report more frequent complications and lower success rates in irradiated patients [15][16][17]. While others do not find any difference between irradiated and non-irradiated patients [18,19].…”

A Review of the Complications and Results of Implantation of the AMS Artificial Urinary Sphincter

“…Implantation of the AUS after radiotherapy was reported in several studies [50, 73, 81, 120, 121, 122]. Mundy considers this a relative contraindication of implantation [69, 121], quoting an erosion risk of 57%.…”