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The Artificial Urinary Sphincter

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Prosthetic Surgery in Urology

Abstract

The artificial urinary sphincter (AUS) is the gold-standard treatment for male stress urinary incontinence. This chapter covers the history of AUS development and the technical modifications that have resulted in the most commonly used device worldwide, the AMS 800. The indications and contraindications to surgery are highlighted, followed by a discussion of the importance of accurate patient investigation and assessment prior to surgery. The surgical technique to insert an AUS is followed by a review of the outcomes of sphincter implantation. Finally the management of postoperative complications and device malfunction are discussed

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References

  1. Foley FE. An artificial sphincter; a new device and operation for control of enuresis and urinary incontinence. J Urol. 1947;58(4):250–9.

    CAS  PubMed  Google Scholar 

  2. Scott FB, Bradley WE, Timm GW, Kothari D. Treatment of incontinence secondary to myelodysplasia by an implantable prosthetic urinary sphincter. South Med J. 1973;66(9):987–90.

    Article  CAS  PubMed  Google Scholar 

  3. Montague DK. Treatment of male incontinence: historical review. In continence: current concepts and treatment strategies. New York: Springer; 2009.

    Google Scholar 

  4. Scott FB. The use of the artificial sphincter in the treatment of urinary incontinence in the female patient. Urol Clin North Am. 1985;12(2):305–15.

    CAS  PubMed  Google Scholar 

  5. Light JK, Reynolds JC. Impact of the new cuff design on reliability of the AS800 artificial urinary sphincter. J Urol. 1992;147(3):609–11.

    CAS  PubMed  Google Scholar 

  6. Leo ME, Barrett DM. Success of the narrow-backed cuff design of the AMS800 artificial urinary sphincter: analysis of 144 patients. J Urol. 1993;150(5 Pt 1):1412–4.

    CAS  PubMed  Google Scholar 

  7. Thuroff JW, Abrams P, Andersson K-E, Artibani W, Chapple CR, Drake MJ, et al. EAU guidelines on urinary incontinence. Eur Urol. 2011;59(3):387–400.

    Article  PubMed  Google Scholar 

  8. Comiter C. Surgery for postprostatectomy incontinence: which procedure for which patient? Nat Rev Urol. 2015;12(2):91–9.

    Article  PubMed  Google Scholar 

  9. Collado Serra A, Resel Folkersma L, Dominguez-Escrig JL, Gomez-Ferrer A, Rubio-Briones J, Solsona NE. AdVance/AdVance XP transobturator male slings: preoperative degree of incontinence as predictor of surgical outcome. Urology. 2013;81(5):1034–9.

    Article  PubMed  Google Scholar 

  10. Flynn BJ, Webster GD. Evaluation and surgical management of intrinsic sphincter deficiency after radical prostatectomy. Rev Urol. 2004;6(4):180–6.

    PubMed  PubMed Central  Google Scholar 

  11. www.mastertrial.co.uk.

  12. Bauer RM, Gozzi C, Hubner W, Nitti VW, Novara G, Peterson A, et al. Contemporary management of postprostatectomy incontinence. Eur Urol. 2011;59(6):985–96.

    Article  PubMed  Google Scholar 

  13. Galli S, Simonato A, Bozzola A, Gregori A, Lissiani A, Scaburri A, et al. Oncologic outcome and continence recovery after laparoscopic radical prostatectomy: 3 years’ follow-up in a “second generation center”. Eur Urol. 2006;49(5):859–65.

    Article  PubMed  Google Scholar 

  14. Lepor H, Kaci L. The impact of open radical retropubic prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments. J Urol. 2004;171(3):1216–9.

    Article  PubMed  Google Scholar 

  15. Kumar A, Litt ER, Ballert KN, Nitti VW. Artificial urinary sphincter versus male sling for post-prostatectomy incontinence – what do patients choose? J Urol. 2009;181(3):1231–5.

    Article  PubMed  Google Scholar 

  16. Bauer RM, Soljanik I, Fullhase C, Karl A, Becker A, Stief CG, et al. Mid-term results for the retroluminar transobturator sling suspension for stress urinary incontinence after prostatectomy. BJU Int. 2011;108(1):94–8.

    Article  PubMed  Google Scholar 

  17. Torrey R, Rajeshuni N, Ruel N, Muldrew S, Chan K. Radiation history affects continence outcomes after advance transobturator sling placement in patients with post-prostatectomy incontinence. Urology. 2013;82(3):713–7.

    Article  PubMed  Google Scholar 

  18. Jura YH, Comiter CV. Urodynamics for postprostatectomy incontinence: when are they helpful and how do we use them? Urol Clin North Am. 2014;41(3):419–27, viii.

    Article  PubMed  Google Scholar 

  19. Lai HH, Hsu EI, Boone TB. Urodynamic testing in evaluation of postradical prostatectomy incontinence before artificial urinary sphincter implantation. Urology. 2009;73(6):1264–9.

    Article  PubMed  Google Scholar 

  20. Grabe M, Bartolletti R, Bjerklund Johnasen T, Cai T, Cek M, Koves B, et al. European Association of Urology Guidelines on Urological Infections. http://www.uroweborg/wp-content/uploads/EAU-Guidelines-Urological-Infections-v2pdf. 2015.

  21. Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK, et al. EAU guidelines on surgical treatment of urinary incontinence. Eur Urol. 2012;62(6):1118–29.

    Article  PubMed  Google Scholar 

  22. Imamoglu MA, Tuygun C, Bakirtas H, Yigitbasi O, Kiper A. The comparison of artificial urinary sphincter implantation and endourethral macroplastique injection for the treatment of postprostatectomy incontinence. Eur Urol. 2005;47(2):209–13.

    Article  PubMed  Google Scholar 

  23. Elliott DS, Barrett DM. Mayo clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol. 1998;159(April):1206–8.

    CAS  PubMed  Google Scholar 

  24. Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB. 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol. 2007;177(3):1021–5.

    Article  PubMed  Google Scholar 

  25. Litwiller SE, Kim KB, Fone PD, White RW, Stone AR. Post-prostatectomy incontinence and the artificial urinary sphincter: a long-term study of patient satisfaction and criteria for success. J Urol. 1996;156(6):1975–80.

    Article  CAS  PubMed  Google Scholar 

  26. Raj GV, Peterson AC, Toh KL, Webster GD. Outcomes following revisions and secondary implantation of the artificial urinary sphincter. J Urol. 2005;173(4):1242–5.

    Article  PubMed  Google Scholar 

  27. Kim SP, Sarmast Z, Daignault S, Faerber GJ, McGuire EJ, Latini JM. Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol. 2008;179(5):1912–6.

    Article  PubMed  Google Scholar 

  28. Venn SN, Greenwell TJ, Mundy AR. The long-term outcome of artificial urinary sphincters. J Urol. 2000;164(September):702–6; discussion 6–7.

    Article  CAS  PubMed  Google Scholar 

  29. Haab F, Trockman BA, Zimmern PE, Leach GE. Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3.5 years of followup. J Urol. 1997;158(2):435–9.

    Article  CAS  PubMed  Google Scholar 

  30. Montague DK, Angermeier KW, Paolone DR. Long-term continence and patient satisfaction after artificial sphincter implantation for urinary incontinence after prostatectomy. J Urol. 2001;166(2):547–9.

    Article  CAS  PubMed  Google Scholar 

  31. Gousse AE, Madjar S, Lambert MM, Fishman IJ. Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: long-term subjective results. J Urol. 2001;166(5):1755–8.

    Article  CAS  PubMed  Google Scholar 

  32. Clemens JQ, Schuster TG, Konnak JW, McGuire EJ, Faerber GJ. Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: actuarial analysis. J Urol. 2001;166(4):1372–5.

    Article  CAS  PubMed  Google Scholar 

  33. James MH, McCammon KA. Artificial urinary sphincter for post-prostatectomy incontinence: a review. Int J Urol. 2014;21(6):536–43.

    Article  PubMed  Google Scholar 

  34. Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN. The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol. 2013;63(4):681–9.

    Article  PubMed  Google Scholar 

  35. Walsh IK, Williams SG, Mahendra V, Nambirajan T, Stone AR. Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction. BJU Int. 2002;89(4):364–8.

    Article  CAS  PubMed  Google Scholar 

  36. Bates AS, Martin RM, Terry TR. Complications following artificial urinary sphincter placement after radical prostatectomy and radiotherapy: a meta-analysis. BJU Int. 2015;116:623–33.

    Article  PubMed  Google Scholar 

  37. Sandhu JS, Maschino AC, Vickers AJ. The surgical learning curve for artificial urinary sphincter procedures compared to typical surgeon experience. Eur Urol. 2011;60(6):1285–90.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Henry GD, Graham SM, Cornell RJ, Cleves MA, Simmons CJ, Vakalopoulos I, et al. A multicenter study on the perineal versus penoscrotal approach for implantation of an artificial urinary sphincter: cuff size and control of male stress urinary incontinence. J Urol. 2009;182(5):2404–9.

    Article  PubMed  Google Scholar 

  39. Linder BJ, de Cogain M, Elliott DS. Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection. J Urol. 2014;191(3):734–8.

    Article  PubMed  Google Scholar 

  40. Lai HH, Boone TB. Complex artificial urinary sphincter revision and reimplantation cases – how do they fare compared to virgin cases? J Urol. 2012;187(3):951–5.

    Article  PubMed  Google Scholar 

  41. Lee D, Zafirakis H, Shapiro A, Westney OL. Intermediate outcomes after transcorporal placement of an artificial urinary sphincter. Int J Urol. 2012;19(9):861–6.

    Article  PubMed  Google Scholar 

  42. DiMarco DS, Elliott DS. Tandem cuff artificial urinary sphincter as a salvage procedure following failed primary sphincter placement for the treatment of post-prostatectomy incontinence. J Urol. 2003;170(4 Pt 1):1252–4.

    Article  PubMed  Google Scholar 

  43. Guralnick ML, Miller E, Toh KL, Webster GD. Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol. 2002;167(5):2075–8; discussion 9.

    Article  PubMed  Google Scholar 

  44. Bell BB, Mulcahy JJ. Management of cuff erosion of the double cuff artificial urinary sphincter. J Urol. 2000;163(1):85–6.

    Article  CAS  PubMed  Google Scholar 

  45. Kowalczyk JJ, Spicer DL, Mulcahy JJ. Erosion rate of the double cuff AMS800 artificial urinary sphincter: long-term followup. J Urol. 1996;156(4):1300–1.

    Article  CAS  PubMed  Google Scholar 

  46. Wiedemann L, Cornu JN, Haab E, Peyrat L, Beley S, Cathelineau X, et al. Transcorporal artificial urinary sphincter implantation as a salvage surgical procedure for challenging cases of male stress urinary incontinence: surgical technique and functional outcomes in a contemporary series. BJU Int. 2013;112(8):1163–8.

    Article  PubMed  Google Scholar 

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Correspondence to Evangelos Zacharakis PhD, FRCS (Urol), FECSM, FEAA .

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© 2016 Springer International Publishing Switzerland

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Malde, S., Sahai, A., Zacharakis, E. (2016). The Artificial Urinary Sphincter. In: Muneer, A., Pearce, I., Ralph, D. (eds) Prosthetic Surgery in Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-13859-6_14

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  • DOI: https://doi.org/10.1007/978-3-319-13859-6_14

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-13859-6

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