Skip to main content

Advertisement

SpringerLink
Log in

A Systematic Approach to the Evaluation and Management of the Failed Artificial Urinary Sphincter

  • Female Urology (K Kobashi, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

In men with post-prostatectomy incontinence, persistent or recurrent urinary leakage following artificial urinary sphincter placement is a frustrating complaint. Surgical failure can be classified as occurring early in the post-operative period vs. late—following a period of established continence—and should be managed according to the time course and severity of urinary leakage. We present a systematic approach for the evaluation and treatment of the failed artificial urinary sphincter. After considering the patient’s individualized treatment goals and impact on quality of life, the clinician can more appropriately advise patients on a management strategy for their recurrent or persistent urinary incontinence following artificial urinary sphincter placement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AUS:

Artificial urinary sphincter

ISD:

Intrinsic sphincter deficiency

PPI:

Post-prostatectomy incontinence

PRB:

Pressure regulating balloon

SUI:

Stress urinary incontinence

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kim PH, Pinheiro LC, Atoria CL, Eastham JA, Sandhu JS, Elkin EB. Trends in the use of incontinence procedures after radical prostatectomy: a population based analysis. J Urol. 2013;189(2):602–8.

    Article  PubMed  Google Scholar 

  2. Martins FE, Boyd SD. Artificial urinary sphincter in patients following major pelvic surgery and/or radiotherapy: are they less favorable candidates? J Urol. 1995;153(4):1188–93.

    Article  CAS  PubMed  Google Scholar 

  3. 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 

  4. Kuznetsov DD, Kim HL, Patel RV, Steinberg GD, Bales GT. Comparison of artificial urinary sphincter and collagen for the treatment of postprostatectomy incontinence. Urology. 2000;56(4):600–3.

    Article  CAS  PubMed  Google Scholar 

  5. 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(4):1206–8.

    Article  CAS  PubMed  Google Scholar 

  6. 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 

  7. 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 

  8. Fleshner N, Herschorn S. The artificial urinary sphincter for post-radical prostatectomy incontinence: impact on urinary symptoms and quality of life. J Urol. 1996;155(4):1260–4.

    Article  CAS  PubMed  Google Scholar 

  9. 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 

  10. Pérez LM, Webster GD. Successful outcome of artificial urinary sphincters in men with post-prostatectomy urinary incontinence despite adverse implantation features. J Urol. 1992;148(4):1166–70.

    PubMed  Google Scholar 

  11. Gomha MA, Boone TB. Artificial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis. J Urol. 2002;167(2 Pt 1):591–6.

    PubMed  Google Scholar 

  12. Montague DK. The artificial urinary sphincter (AS 800): experience in 166 consecutive patients. J Urol. 1992;147(2):380–2.

    CAS  PubMed  Google Scholar 

  13. Mottet N, Boyer C, Chartier-Kastler E, Ben Naoum K, Richard F, Costa P. Artificial urinary sphincter AMS 800 for urinary incontinence after radical prostatectomy: the French experience. Urol Int. 1998;60 Suppl 2:25–9. discussion 35.

    Article  PubMed  Google Scholar 

  14. Klijn AJ, Hop WC, Mickisch G, Schröder FH, Bosch JL. The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 year actuarial adequate function rates. Br J Urol. 1998;82(4):530–3.

    Article  CAS  PubMed  Google Scholar 

  15. Goldwasser B, Furlow WL, Barrett DM. The model AS 800 artificial urinary sphincter: Mayo Clinic experience. J Urol. 1987;137(4):668–71.

    CAS  PubMed  Google Scholar 

  16. 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 

  17. 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 

  18. Lai HH, Boone TB. Implantation of artificial urinary sphincter in patients with post-prostatectomy incontinence, and preoperative overactive bladder and mixed symptoms. J Urol. 2011;185(6):2254–9.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Fulford SC, Sutton C, Bales G, Hickling M, Stephenson TP. The fate of the “modern” artificial urinary sphincter with a follow-up of more than 10 years. Br J Urol. 1997;79(5):713–6.

    Article  CAS  PubMed  Google Scholar 

  21. Brito CG, Mulcahy JJ, Mitchell ME, Adams MC. Use of a double cuff AMS800 urinary sphincter for severe stress incontinence. J Urol. 1993;149(2):283–5.

    CAS  PubMed  Google Scholar 

  22. 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 

  23. 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 2079.

    Article  PubMed  Google Scholar 

  24. 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 

  25. O’Connor RC, Gerber GS, Avila D, Chen AA, Bales GT. Comparison of outcomes after single or DOUBLE-CUFF artificial urinary sphincter insertion. Urology. 2003;62(4):723–6.

    Article  PubMed  Google Scholar 

  26. O’Connor RC, Lyon MB, Guralnick ML, Bales GT. Long-term follow-up of single versus double cuff artificial urinary sphincter insertion for the treatment of severe postprostatectomy stress urinary incontinence. Urology. 2008;71(1):90–3.

    Article  PubMed  Google Scholar 

  27. Barnard J, van Rij S, Westenberg AM. A Valsalva leak-point pressure of >100 cmH2O is associated with greater success in AdVanceTM sling placement for the treatment of post-prostatectomy urinary incontinence. BJU Int. 2014;114 Suppl 1:34–7.

    Article  PubMed  Google Scholar 

  28. Manunta A, Guillé F, Patard JJ, Lobel B. Artificial sphincter insertion after radiotherapy: is it worthwhile? BJU Int. 2000;85(4):490–2.

    Article  CAS  PubMed  Google Scholar 

  29. Hird AE, Radomski SB. Artificial urinary sphincter erosion after radical prostatectomy in patients treated with and without radiation. Can Urol Assoc J. 2015;9(5–6):E354–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hoy NY, Rourke KF. Artificial urinary sphincter outcomes in the “fragile urethra.”. Urology. 2015;86(3):618–24.

    Article  PubMed  Google Scholar 

  31. 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 

  32. •• Simhan J, Morey AF, Zhao LC, Tausch TJ, Scott JF, Hudak SJ, et al. Decreasing need for artificial urinary sphincter revision surgery by precise cuff sizing in men with spongiosal atrophy. J Urol. 2014;192(3):798–803. In a sample of 236 men who underwent AUS at one institution, 4.0 cm cuff revisions improved from 22.2% down to 4.7% after introduction of the 3.5-cm cuff, consistent with a national sample demonstrating a decrease in early revision rate from 16.2% in 2008–2009, down to 7.5% in 2010–2012, allowing for more precise cuff sizing in men with urethral circumference less than 4.0 cm.

    Article  PubMed  Google Scholar 

  33. Chung E, Ranaweera M, Cartmill R. Newer and novel artificial urinary sphincters (AUS): the development of alternatives to the current AUS device. BJU Int. 2012;110 Suppl 4:5–11.

    Article  PubMed  Google Scholar 

  34. Choe JM, Battino BS, Bell TE. Retrograde perfusion sphincterometry with a flexible cystoscope: method of troubleshooting the AMS 800. Urology. 2000;56(2):317–9.

    Article  CAS  PubMed  Google Scholar 

  35. Leach GE, Raz S. Perfusion sphincterometry. Method of intraoperative evaluation of artificial urinary sphincter function. Urology. 1983;21(3):312–4.

    Article  CAS  PubMed  Google Scholar 

  36. Hajivassiliou CA. The development and evolution of artificial urethral sphincters. J Med Eng Technol. 1998;22(4):154–9.

    Article  CAS  PubMed  Google Scholar 

  37. Rose SC, Hansen ME, Webster GD, Zakrzewski C, Cohan RH, Dunnick NR. Artificial urinary sphincters: plain radiography of malfunction and complications. Radiology. 1988;168(2):403–8.

    Article  CAS  PubMed  Google Scholar 

  38. Brucker BM, Demirtas A, Fong E, Kelly C, Nitti VW. Artificial urinary sphincter revision: the role of ultrasound. Urology. 2013;82(6):1424–8.

    Article  PubMed  Google Scholar 

  39. AMS 800 Urinary Control System for Male Patients. Operating room manual. Minnetonka: American Medical Systems, Inc; 2014. p. 40.

    Google Scholar 

  40. Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2464–72.

    Article  PubMed  Google Scholar 

  41. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.

    Article  PubMed  Google Scholar 

  42. Gormley EA, Lightner DJ, Faraday M, Vasavada SP. American Urological Association, Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193(5):1572–80.

    Article  PubMed  Google Scholar 

  43. Smith PJ, Hudak SJ, Scott JF, Zhao LC, Morey AF. Transcorporal artificial urinary sphincter cuff placement is associated with a higher risk of postoperative urinary retention. Can J Urol. 2013;20(3):6773–7.

    PubMed  Google Scholar 

  44. Linder BJ, Piotrowski JT, Ziegelmann MJ, Rivera ME, Rangel LJ, Elliott DS. Perioperative complications following artificial urinary sphincter placement. J Urol. 2015;194(3):716–20.

    Article  PubMed  Google Scholar 

  45. Chung E, Cartmill R. Diagnostic challenges in the evaluation of persistent or recurrent urinary incontinence after artificial urinary sphincter (AUS) implantation in patients after prostatectomy. BJU Int. 2013;112 Suppl 2:32–5.

    Article  Google Scholar 

  46. Biardeau X, Aharony S, AUS Consensus Group, Campeau L, Corcos J. Artificial urinary sphincter: report of the 2015 Consensus Conference. Neurourol Urodyn. 2016;35 Suppl 2:S8–24.

    Article  PubMed  Google Scholar 

  47. Peterson AC, Webster GD. Artificial urinary sphincter: lessons learned. Urol Clin North Am. 2011;38(1):83–8. vii.

    Article  PubMed  Google Scholar 

  48. Maillet F, Buzelin J-M, Bouchot O, Karam G. Management of artificial urinary sphincter dysfunction. Eur Urol. 2004;46(2):241–5. discussion 246.

    Article  PubMed  Google Scholar 

  49. •• Linder BJ, Viers BR, Ziegelmann MJ, Rivera ME, Rangel LJ, Elliott DS. Artificial urinary sphincter mechanical failures—is it better to replace the entire device or just the malfunctioning component? J Urol. 2016;195(5):1523–8. Out of 1082 primary AUS placements, 125 demonstrated mechanical failure at a median follow-up of 4.2 years. The authors found no statistically significant difference in 3-year device survival after replacement of a single component if a single component was identified as the source of leakage vs. replacement of the entire device.

    Article  PubMed  Google Scholar 

  50. Selph JP, Belsante MJ, Gupta S, Ajay D, Lentz A, Webster G, et al. The ohmmeter identifies the site of fluid leakage during artificial urinary sphincter revision surgery. J Urol. 2015;194(4):1043–8.

    Article  PubMed  Google Scholar 

  51. Webster GD, Sherman ND. Management of male incontinence following artificial urinary sphincter failure. Curr Opin Urol. 2005;15(6):386–90.

    Article  PubMed  Google Scholar 

  52. • Eswara JR, Chan R, Vetter JM, Lai HH, Boone TB, Brandes SB. Revision techniques after artificial urinary sphincter failure in men: results from a multicenter study. Urology. 2015;86(1):176–80.

    Article  PubMed  Google Scholar 

  53. Bryan DE, Mulcahy JJ, Simmons GR. Salvage procedure for infected noneroded artificial urinary sphincters. J Urol. 2002;168(6):2464–6.

    Article  PubMed  Google Scholar 

  54. Wang R, McGuire EJ, He C, Faerber GJ, Latini JM. Long-term outcomes after primary failures of artificial urinary sphincter implantation. Urology. 2012;79(4):922–8.

    Article  PubMed  Google Scholar 

  55. Spiess PE, Capolicchio JP, Kiruluta G, Salle JP, Berardinucci G, Corcos J. Is an artificial sphincter the best choice for incontinent boys with Spina Bifida? Review of our long term experience with the AS-800 artificial sphincter. Can J Urol. 2002;9(2):1486–91.

    PubMed  Google Scholar 

  56. Castera R, Podestá ML, Ruarte A, Herrera M, Medel R. 10-Year experience with artificial urinary sphincter in children and adolescents. J Urol. 2001;165(6 Pt 2):2373–6.

    Article  CAS  PubMed  Google Scholar 

  57. Simeoni J, Guys JM, Mollard P, Buzelin JM, Moscovici J, Bondonny JM, et al. Artificial urinary sphincter implantation for neurogenic bladder: a multi-institutional study in 107 children. Br J Urol. 1996;78(2):287–93.

    Article  CAS  PubMed  Google Scholar 

  58. Holmes NM, Kogan BA, Baskin LS. Placement of artificial urinary sphincter in children and simultaneous gastrocystoplasty. J Urol. 2001;165(6 Pt 2):2366–8.

    Article  CAS  PubMed  Google Scholar 

  59. Motley RC, Barrett DM. Artificial urinary sphincter cuff erosion. Experience with reimplantation in 38 patients. Urology. 1990;35(3):215–8.

    Article  CAS  PubMed  Google Scholar 

  60. Trost L, Elliott D. Small intestinal submucosa urethral wrap at the time of artificial urinary sphincter placement as a salvage treatment option for patients with persistent/recurrent incontinence following multiple prior sphincter failures and erosions. Urology. 2012;79(4):933–8.

    Article  PubMed  Google Scholar 

  61. Rehder P, Pinggera G-M, Mitterberger M, Pelzer AE, Gozzi C, Herwig R. Urethral support with PelviSoft after artificial urinary sphincter erosion at revision procedures. Wien Med Wochenschr. 2007;157(7–8):170–2.

    Article  PubMed  Google Scholar 

  62. • Rozanski AT, Tausch TJ, Ramirez D, Simhan J, Scott JF, Morey AF. Immediate urethral repair during explantation prevents stricture formation after artificial urinary sphincter cuff erosion. J Urol. 2014;192(2):442–6.

    Article  PubMed  Google Scholar 

  63. 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 

  64. • Viers BR, Linder BJ, Rivera ME, Rangel LJ, Ziegelmann MJ, Elliott DS. Long-term quality of life and functional outcomes among primary and secondary artificial urinary sphincter implantations in men with stress urinary incontinence. J Urol. 2016;196(3):838–43.

    Article  PubMed  Google Scholar 

  65. • Singla N, Siegel JA, Simhan J, Tausch TJ, Klein A, Thoreson GR, et al. Does pressure regulating balloon location make a difference in functional outcomes of artificial urinary sphincter? J Urol. 2015;194(1):202–6.

    Article  PubMed  Google Scholar 

  66. Chung PH, Morey AF, Tausch TJ, Simhan J, Scott JF. High submuscular placement of urologic prosthetic balloons and reservoirs: 2-year experience and patient-reported outcomes. Urology. 2014;84(6):1535–40.

    Article  PubMed  Google Scholar 

  67. 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 

  68. McGeady JB, McAninch JW, Truesdale MD, Blaschko SD, Kenfield S, Breyer BN. Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol. 2014;192(6):1756–61.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Rivera ME, Linder BJ, Ziegelmann MJ, Viers BR, Rangel LJ, Elliott DS. The impact of prior radiation therapy on artificial urinary sphincter device survival. J Urol. 2016;195(4P1):1033–7.

    Article  PubMed  Google Scholar 

  70. Kretschmer A, Buchner A, Grabbert M, Stief CG, Pavlicek M, Bauer RM. Risk factors for artificial urinary sphincter failure. World J Urol. 2016;34(4):595–602.

    Article  PubMed  Google Scholar 

  71. Brant WO, Erickson BA, Elliott SP, Powell C, Alsikafi N, McClung C, et al. Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology. 2014;84(4):934–8.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Hudak SJ, Morey AF. Impact of 3.5 cm artificial urinary sphincter cuff on primary and revision surgery for male stress urinary incontinence. J Urol. 2011;186(5):1962–6.

    Article  PubMed  Google Scholar 

  73. Le Long E, Rebibo JD, Nouhaud FX, Grise P. Transcorporal artificial urinary sphincter in radiated and non-radiated compromised urethra. Assessment with a minimum 2 year follow-up. Int Braz J Urol. 2016;42(3):494–500.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Mock S, Dmochowski RR, Brown ET, Reynolds WS, Kaufman MR, Milam DF. The impact of urethral risk factors on transcorporeal artificial urinary sphincter erosion rates and device survival. J Urol. 2015;194(6):1692–6.

    Article  PubMed  Google Scholar 

  75. Bugeja S, Ivaz SL, Frost A, Andrich DE, Mundy AR. Urethral atrophy after implantation of an artificial urinary sphincter: fact or fiction? BJU Int. 2016;117(4):669–76.

    Article  PubMed  Google Scholar 

  76. Singla N, Singla AK. Review of single-surgeon 10-year experience with artificial urinary sphincter with report of sterile cuff erosion managed nonsurgically. Urology. 2015;85(1):252–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA, 94305, USA

    Amy D. Dobberfuhl & Craig V. Comiter

Authors
  1. Amy D. Dobberfuhl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Craig V. Comiter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Craig V. Comiter.

Ethics declarations

Conflict of Interest

Amy D. Dobberfuhl is a Principle Investigator for SUFU Foundation Study of Chemodenervation funded by the Allergan Foundation.

Craig V. Comiter is a consultant and clinical investigator for Coloplast.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Female Urology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dobberfuhl, A.D., Comiter, C.V. A Systematic Approach to the Evaluation and Management of the Failed Artificial Urinary Sphincter. Curr Urol Rep 18, 18 (2017). https://doi.org/10.1007/s11934-017-0666-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-017-0666-y

Keywords

Search

Navigation