Skip to main content

Advertisement

SpringerLink
Log in

Artificial Urinary Sphincter Complications: Risk Factors, Workup, and Clinical Approach

  • Men's Health (R Carrion, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review risk factors for AUS complications and present a systematic approach to their diagnosis and management.

Recent Findings

Established risk factors for AUS complications include catheterization, channel TURP, pelvic radiation, urethroplasty, anticoagulation, cardiovascular disease, diabetes mellitus, frailty index, hypertension, low albumin, and low testosterone. We present our algorithm for diagnosis and management of AUS complications.

Summary

Despite being the gold standard of treatment for men with SUI, major and minor complications can occur at any point after AUS insertion. Careful consideration of the urologic, medical, and operative risk factors for each patient can help prevent complications. A systematic approach to early and late complications facilitates their identification and effective management. The evaluating urologist must have a thorough understanding of potential AUS complications in order to restore quality of life in men with bothersome SUI.

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
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

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

  1. Tutolo M, Cornu J-N, Bauer RM, Ahyai S, Bozzini G, Heesakkers J, et al. Efficacy and safety of artificial urinary sphincter (AUS): results of a large multi-institutional cohort of patients with mid-term follow-up. Neurourol Urodyn. 2019;38(2):710–8. https://doi.org/10.1002/nau.23901.

    Article  PubMed  Google Scholar 

  2. 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. https://doi.org/10.1016/j.juro.2016.03.076.

    Article  PubMed  Google Scholar 

  3. •• Khouri RK, Ortiz NM, Baumgarten AS, et al. Artificial urinary sphincter outperforms sling for moderate male stress urinary incontinence. Urology. 2020. https://doi.org/10.1016/j.urology.2020.03.028Demonstrates the expanded role for AUS in male SUI.

  4. Sacco E, Gandi C, Marino F, Totaro A, di Gianfrancesco L, Palermo G, et al. Artificial urinary sphincter significantly better than fixed sling for moderate postprostatectomy stress urinary incontinence: a propensity score-matched study. BJU Int. 2020;127:229–37. https://doi.org/10.1111/bju.15197.

    Article  PubMed  Google Scholar 

  5. Kaiho Y, Masuda H, Takei M, Hirayama T, Mitsui T, Yokoyama M, et al. Surgical and patient reported outcomes of artificial urinary sphincter implantation: a multicenter, prospective, observational study. J Urol. 2018;199(1):245–50. https://doi.org/10.1016/j.juro.2017.08.077.

    Article  PubMed  Google Scholar 

  6. Te Dorsthorst MJ, van der Doelen MJ, Farag F, Martens FMJ, Heesakkers JPFA. Survival of the artificial urinary sphincter in a changing patient profile. World J Urol. 2019;37(5):899–906. https://doi.org/10.1007/s00345-018-2448-7.

    Article  Google Scholar 

  7. 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(4 Pt 1):1033–7. https://doi.org/10.1016/j.juro.2015.10.119.

    Article  PubMed  Google Scholar 

  8. Averbeck MA, Woodhouse C, Comiter C, Bruschini H, Hanus T, Herschorn S, et al. Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: report from the 6th International Consultation on Incontinence. Neurourol Urodyn. 2019;38(1):398–406. https://doi.org/10.1002/nau.23845.

    Article  PubMed  Google Scholar 

  9. Linder BJ, Rangel LJ, Elliott DS. Evaluating success rates after artificial urinary sphincter placement: a comparison of clinical definitions. Urology. 2018;113:220–4. https://doi.org/10.1016/j.urology.2017.10.033.

    Article  PubMed  Google Scholar 

  10. Wingate JT, Erickson BA, Murphy G, Smith TG, Breyer BN, Voelzke BB, et al. Multicenter analysis of patient reported outcomes following artificial urinary sphincter placement for male stress urinary incontinence. J Urol. 2018;199(3):785–90. https://doi.org/10.1016/j.juro.2017.09.089.

    Article  PubMed  Google Scholar 

  11. • Sandhu JS, Breyer B, Comiter C, et al. Incontinence after prostate treatment: AUA/SUFU Guideline. J Urol. 2019;202(2):369–78. https://doi.org/10.1097/JU.0000000000000314Provides clinical guidelines for male SUI.

    Article  PubMed  Google Scholar 

  12. Boswell TC, Elliott DS, Rangel LJ, Linder BJ. Long-term device survival and quality of life outcomes following artificial urinary sphincter placement. Transl Androl Urol. 2020;9(1):56–61. https://doi.org/10.21037/tau.2019.08.02.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Radomski SB, Ruzhynsky V, Wallis CJD, Herschorn S. Complications and interventions in patients with an artificial urinary sphincter: long-term results. J Urol. 2018;200(5):1093–8. https://doi.org/10.1016/j.juro.2018.05.143.

    Article  PubMed  Google Scholar 

  14. DeLay KJ, Haney NM, Chiang J, et al. Comparison of adjuvant radiation therapy before or after artificial urinary sphincter placement: a multi-institutional, retrospective analysis. Urology. 2018;113:160–5. https://doi.org/10.1016/j.urology.2017.11.041.

    Article  PubMed  Google Scholar 

  15. Linder BJ, Rivera ME, Ziegelmann MJ, Elliott DS. Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at Mayo Clinic. Urology. 2015;86(3):602–7. https://doi.org/10.1016/j.urology.2015.05.029.

    Article  PubMed  Google Scholar 

  16. Fuchs JS, Shakir N, McKibben MJ, Scott JM, Morey AF. Prolonged duration of incontinence for men before initial anti-incontinence surgery: an opportunity for improvement. Urology. 2018;119:149–54. https://doi.org/10.1016/j.urology.2018.05.006.

    Article  PubMed  Google Scholar 

  17. Nelson M, Dornbier R, Kirshenbaum E, Eguia E, Sweigert P, Baker M, et al. Use of surgery for post-prostatectomy incontinence. J Urol. 2020;203(4):786–91. https://doi.org/10.1097/JU.0000000000000618.

    Article  PubMed  Google Scholar 

  18. Seideman CA, Zhao LC, Hudak SJ, Mierzwiak J, Adibi M, Morey AF. Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion? Urology. 2013;82(4):943–6. https://doi.org/10.1016/j.urology.2013.06.044.

    Article  PubMed  Google Scholar 

  19. Khene Z-E, Paret F, Perrouin-Verbe M-A, Prudhomme T, Hascoet J, Nedelec M, et al. Artificial urinary sphincter in male patients with Spina bifida: comparison of perioperative and functional outcomes between bulbar urethra and bladder neck cuff placement. J Urol. 2018;199(3):791–7. https://doi.org/10.1016/j.juro.2017.09.140.

    Article  PubMed  Google Scholar 

  20. Cohen AJ, Boysen W, Kuchta K, Faris S, Milose J. Artificial urinary sphincter longevity following transurethral resection of the prostate in the setting of prostate cancer. World J Urol. 2019;37(12):2755–61. https://doi.org/10.1007/s00345-019-02684-z.

    Article  PubMed  Google Scholar 

  21. 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. https://doi.org/10.1016/j.juro.2015.06.088.

    Article  PubMed  Google Scholar 

  22. 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. https://doi.org/10.1016/j.juro.2014.06.088.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fuller TW, Ballon-Landa EE, Gallo K, et al. Outcomes and risk factors of revision and replacement artificial urinary sphincter implantation in radiated and non-radiated patients. J Urol. 2020. https://doi.org/10.1097/JU.0000000000000749.

  24. Srivastava A, Joice GA, Patel HD, Manka MG, Sopko NA, Wright EJ. Impact of adjuvant radiation on artificial urinary sphincter durability in postprostatectomy patients. Urology. 2018;114:212–7. https://doi.org/10.1016/j.urology.2017.12.029.

    Article  PubMed  Google Scholar 

  25. Moser DC, Kaufman MR, Milam DF, Johnsen NV, Cleves MA, Broghammer JA, et al. Impact of radiation and transcorporeal artificial sphincter placement in patients with prior urethral cuff erosion: results from a retrospective multicenter analysis. J Urol. 2018;200(6):1338–43. https://doi.org/10.1016/j.juro.2018.06.069.

    Article  PubMed  Google Scholar 

  26. Kaufman MR, Milam DF, Johnsen NV, Cleves MA, Broghammer JA, Brant WO, et al. Prior radiation therapy decreases time to idiopathic erosion of artificial urinary sphincter: a multi-institutional analysis. J Urol. 2018;199(4):1037–41. https://doi.org/10.1016/j.juro.2017.11.046.

    Article  PubMed  Google Scholar 

  27. Hüsch T, Kretschmer A, Thomsen F, Kronlachner D, Kurosch M, Obaje A, et al. Risk factors for failure of male slings and artificial urinary sphincters: results from a large middle european cohort study. Urol Int. 2017;99(1):14–21. https://doi.org/10.1159/000449232.

    Article  PubMed  Google Scholar 

  28. 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. https://doi.org/10.1007/s00345-015-1662-9.

    Article  PubMed  Google Scholar 

  29. Raj GV, Peterson AC, Webster GD. Outcomes following erosions of the artificial urinary sphincter. J Urol. 2006;175(6):2186–90; discussion 2190. https://doi.org/10.1016/S0022-5347(06)00307-7.

    Article  PubMed  Google Scholar 

  30. 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. https://doi.org/10.1016/j.urology.2014.05.043.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Godwin CA, Linder BJ, Rivera ME, Ziegelmann MJ, Elliott DS. Effects of smoking status on device survival among individuals undergoing artificial urinary sphincter placement. Am J Mens Health. 2018;12(5):1398–402. https://doi.org/10.1177/1557988316651133.

    Article  PubMed  Google Scholar 

  32. Medendorp AR, Anger JT, Jin C, Amin KA, Hampson LA, Lee UJ, et al. The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures. Urology. 2019;129:210–6. https://doi.org/10.1016/j.urology.2019.04.015.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ginsburg KB, Schwabe JR, Cochrane JA, Tapper A, Burks F, Rambhatla A. Low serum albumin correlates with adverse events following surgery for male urinary incontinence: Analysis of the American College of Surgeons National Surgical Quality Improvement Project. Urology. 2020;137:178–82. https://doi.org/10.1016/j.urology.2019.12.004.

    Article  PubMed  Google Scholar 

  34. McKibben MJ, Fuentes J, Shakir N, et al. Low Serum Testosterone is Present in Nearly Half of Men Undergoing Artificial Urinary Sphincter Placement. Urology. 2018;118:208–12. https://doi.org/10.1016/j.urology.2018.04.018.

    Article  PubMed  Google Scholar 

  35. Hofer MD, Morey AF, Sheth K, Tausch TJ, Siegel J, Cordon BH, et al. Low serum testosterone level predisposes to artificial urinary sphincter cuff erosion. Urology. 2016;97:245–9. https://doi.org/10.1016/j.urology.2016.04.065.

    Article  PubMed  Google Scholar 

  36. Hughes M, Caza T, Li G, Daugherty M, Blakley S, Nikolavsky D. Histologic characterization of the post-radiation urethral stenosis in men treated for prostate cancer. World J Urol. 2019;38:2269–77. https://doi.org/10.1007/s00345-019-03031-y.

    Article  CAS  PubMed  Google Scholar 

  37. Tibbs MK. Wound healing following radiation therapy: a review. Radiother Oncol. 1997;42(2):99–106. https://doi.org/10.1016/s0167-8140(96)01880-4.

    Article  CAS  PubMed  Google Scholar 

  38. Maurer V, Marks P, Dahlem R, Rosenbaum C, Meyer CP, Riechardt S, et al. Prospective analysis of artificial urinary sphincter AMS 800 implantation after buccal mucosa graft urethroplasty. World J Urol. 2019;37(4):647–53. https://doi.org/10.1007/s00345-019-02631-y.

    Article  PubMed  Google Scholar 

  39. 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. https://doi.org/10.1016/j.juro.2011.10.153.

    Article  PubMed  Google Scholar 

  40. Rosenbaum CM, Pham T, Dahlem R, Maurer V, Marks P, Vetterlein MW, et al. The impact of surgical sequence on outcome rates of artificial urinary sphincter implantation: comparative effectiveness of primary, secondary and repeat implantation. World J Urol. 2019;38:2289–94. https://doi.org/10.1007/s00345-019-03029-6.

    Article  PubMed  Google Scholar 

  41. Zhang F, Liao L. Artificial urinary sphincter implantation: an important component of complex surgery for urinary tract reconstruction in patients with refractory urinary incontinence. BMC Urol. 2018;18(1):3. https://doi.org/10.1186/s12894-018-0314-y.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Selph JP, Madden-Fuentes R, Peterson AC, Webster GD, Lentz AC. Long-term artificial urinary sphincter outcomes following a prior rectourethral fistula repair. Urology. 2015;86(3):608–12. https://doi.org/10.1016/j.urology.2015.06.012.

    Article  PubMed  Google Scholar 

  43. Heiner SM, Viers BR, Rivera ME, Linder BJ, Elliott DS. What is the fate of artificial urinary sphincters among men undergoing repetitive bladder cancer treatment? Investig Clin Urol. 2018;59(1):44–8. https://doi.org/10.4111/icu.2018.59.1.44.

    Article  PubMed  Google Scholar 

  44. Hofer MD, Kapur P, Cordon BH, Hamoun F, Russell D, Scott JM, et al. Low testosterone levels result in decreased periurethral vascularity via an androgen receptor-mediated process: pilot study in urethral stricture tissue. Urology. 2017;105:175–80. https://doi.org/10.1016/j.urology.2017.02.037.

    Article  PubMed  Google Scholar 

  45. Lavi A, Boone TB, Cohen M, Gross M. The patient beyond the sphincter-cognitive and functional considerations affecting the natural history of artificial urinary sphincters. Urology. 2020;137:14–8. https://doi.org/10.1016/j.urology.2019.11.031.

    Article  CAS  PubMed  Google Scholar 

  46. Kim M, Choi D, Hong JH, Kim C-S, Ahn H, Choo M-S. Factors contributing to treatment outcomes of post-prostatectomy incontinence surgery for the selection of the proper surgical procedure for individual patients: a single-center experience. Neurourol Urodyn. 2018;37(6):1978–87. https://doi.org/10.1002/nau.23543.

    Article  PubMed  Google Scholar 

  47. Ziegelmann MJ, Linder BJ, Avant RA, Elliott DS. Bacterial cultures at the time of artificial urinary sphincter revision surgery in clinically uninfected devices: a contemporary series. J Urol. 2019;201(6):1152–7. https://doi.org/10.1097/JU.0000000000000102.

    Article  PubMed  Google Scholar 

  48. Darouiche RO, Wall MJ, Itani KMF, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1):18–26. https://doi.org/10.1056/NEJMoa0810988.

    Article  CAS  PubMed  Google Scholar 

  49. Yeung LL, Grewal S, Bullock A, Lai HH, Brandes SB. A comparison of chlorhexidine-alcohol versus povidone-iodine for eliminating skin flora before genitourinary prosthetic surgery: a randomized controlled trial. J Urol. 2013;189(1):136–40. https://doi.org/10.1016/j.juro.2012.08.086.

    Article  PubMed  Google Scholar 

  50. Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol. 2020;203(2):351–6. https://doi.org/10.1097/JU.0000000000000509.

    Article  PubMed  Google Scholar 

  51. Kavoussi NL, Siegel JA, Viers BR, Pagliara TJ, Hofer MD, Cordon BH, et al. Preoperative urine culture results correlate poorly with bacteriology of urologic prosthetic device infections. J Sex Med. 2017;14(1):163–8. https://doi.org/10.1016/j.jsxm.2016.10.017.

    Article  PubMed  Google Scholar 

  52. Kavoussi NL, Viers BR, Pagilara TJ, Siegel JA, Hofer MD, Cordon B, et al. Are urine cultures necessary prior to urologic prosthetic surgery? Sex Med Rev. 2018;6(1):157–61. https://doi.org/10.1016/j.sxmr.2017.03.007.

    Article  PubMed  Google Scholar 

  53. Adamsky MA, Boysen WR, Cohen AJ, Ham S, Dmochowski RR, Faris SF, et al. Evaluating the role of postoperative oral antibiotic administration in artificial urinary sphincter and inflatable penile prosthesis explantation: a nationwide analysis. Urology. 2018;111:92–8. https://doi.org/10.1016/j.urology.2017.07.064.

    Article  PubMed  Google Scholar 

  54. Dropkin BM, Chisholm LP, Dallmer JD, Johnsen NV, Dmochowski RR, Milam DF, et al. Penile prosthesis insertion in the era of antibiotic stewardship-are postoperative antibiotics necessary? J Urol. 2020;203(3):611–4. https://doi.org/10.1097/JU.0000000000000578.

    Article  PubMed  Google Scholar 

  55. de Cógáin MR, Elliott DS. The impact of an antibiotic coating on the artificial urinary sphincter infection rate. J Urol. 2013;190(1):113–7. https://doi.org/10.1016/j.juro.2013.01.015.

    Article  CAS  PubMed  Google Scholar 

  56. Hüsch T, Kretschmer A, Thomsen F, Kronlachner D, Kurosch M, Obaje A, et al. Antibiotic coating of the artificial urinary sphincter (AMS 800): is it worthwhile? Urology. 2017;103:179–84. https://doi.org/10.1016/j.urology.2016.12.056.

    Article  PubMed  Google Scholar 

  57. 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. https://doi.org/10.1016/j.juro.2014.03.115.

    Article  PubMed  Google Scholar 

  58. Bergeson RL, Yi YA, Baker RC, Ward EE, Davenport MT, Morey AF. Urethral atrophy is now a rare cause for artificial urinary sphincter revision surgery in the contemporary 3.5 cm cuff era. Transl Androl Urol. 2020;9(1):50–5. https://doi.org/10.21037/tau.2019.07.18.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Loh-Doyle JC, Hartman N, Nazemi A, Wayne K, Doumanian LR, Ginsberg DA, et al. Mechanical failure rates of artificial urinary sphincter components: is the 3.5-cm urethral cuff at higher risk? Neurourol Urodyn. 2019;38(1):187–92. https://doi.org/10.1002/nau.23825.

    Article  PubMed  Google Scholar 

  60. Simhan J, Morey AF, Singla N, Tausch TJ, Scott JF, Lemack GE, et al. 3.5 cm artificial urinary sphincter cuff erosion occurs predominantly in irradiated patients. J Urol. 2015;193(2):593–7. https://doi.org/10.1016/j.juro.2014.07.115.

    Article  PubMed  Google Scholar 

  61. McKibben MJ, Shakir N, Fuchs JS, Scott JM, Morey AF. Erosion rates of 3.5-cm artificial urinary sphincter cuffs are similar to larger cuffs. BJU Int. 2018. https://doi.org/10.1111/bju.14483.

  62. Patel N, Golan R, Halpern JA, Sun T, Asafu-Adjei AD, Chughtai B, et al. A contemporary analysis of dual inflatable penile prosthesis and artificial urinary sphincter outcomes. J Urol. 2019;201(1):141–6. https://doi.org/10.1016/j.juro.2018.07.046.

    Article  PubMed  Google Scholar 

  63. Boysen WR, Cohen AJ, Kuchta K, Park S, Milose J. Combined placement of artificial urinary sphincter and inflatable penile prosthesis does not increase risk of perioperative complications or impact long-term device survival. Urology. 2019;124:264–70. https://doi.org/10.1016/j.urology.2018.10.033.

    Article  PubMed  Google Scholar 

  64. Ajay D, Mendez MH, Wang R, Westney OL. Treatment of urinary incontinence in patients with erectile dysfunction. Sex Med Rev. 2020. https://doi.org/10.1016/j.sxmr.2020.04.006.

  65. Kavoussi NL, Hofer MD, Viers BR, Cordon BH, Mooney RP, Pagliara TJ, et al. Synchronous ipsilateral high submuscular placement of prosthetic balloons and reservoirs. J Sex Med. 2017;14(2):264–8. https://doi.org/10.1016/j.jsxm.2016.12.001.

    Article  PubMed  Google Scholar 

  66. Loh-Doyle JC, Ashrafi A, Nazemi A, Ghodoussipour S, Thompson E, Wayne K, et al. Dual prosthetic implantation after radical cystoprostatectomy and neobladder: outcomes of the inflatable penile prosthesis and artificial urinary sphincter in bladder cancer survivors. Urology. 2019;127:127–32. https://doi.org/10.1016/j.urology.2019.01.010.

    Article  PubMed  Google Scholar 

  67. Sundaram V, Cordon BH, Hofer MD, Morey AF. Is risk of artificial urethral sphincter cuff erosion higher in patients with penile prosthesis? J Sex Med. 2016;13(9):1432–7. https://doi.org/10.1016/j.jsxm.2016.06.013.

    Article  PubMed  Google Scholar 

  68. 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. https://doi.org/10.1016/j.juro.2015.02.2945.

    Article  PubMed  Google Scholar 

  69. Chouhan JD, Terlecki RP. A user’s guide for surgery involving the artificial urinary sphincter. Sex Med Rev. 2019;7(1):167–77. https://doi.org/10.1016/j.sxmr.2018.10.004.

    Article  PubMed  Google Scholar 

  70. 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. https://doi.org/10.1016/j.juro.2014.02.007.

    Article  PubMed  Google Scholar 

  71. Chertack N, Chaparala H, Angermeier KW, Montague DK, Wood HM. Foley or fix: a comparative analysis of reparative procedures at the time of explantation of artificial urinary sphincter for cuff erosion. Urology. 2016;90:173–8. https://doi.org/10.1016/j.urology.2015.11.040.

    Article  PubMed  Google Scholar 

  72. Gross MS, Broghammer JA, Kaufman MR, Milam DF, Brant WO, Cleves MA, et al. Urethral stricture outcomes after artificial urinary sphincter cuff erosion: results from a multicenter retrospective analysis. Urology. 2017;104:198–203. https://doi.org/10.1016/j.urology.2017.01.020.

    Article  PubMed  Google Scholar 

  73. Keihani S, Chandrapal JC, Peterson AC, Broghammer JA, Chertack N, Elliott SP, et al. Outcomes of urethroplasty to treat urethral strictures arising from artificial urinary sphincter erosions and rates of subsequent device replacement. Urology. 2017;107:239–45. https://doi.org/10.1016/j.urology.2017.05.049.

    Article  PubMed  Google Scholar 

  74. 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. https://doi.org/10.1016/j.juro.2009.07.068.

    Article  PubMed  Google Scholar 

  75. Anusionwu I, Miles-Thomas J, Hernandez DJ, Wright EJ. Anatomical and manometric comparison of perineal and transscrotal approaches to artificial urinary sphincter placement. J Urol. 2012;188(5):1834–6. https://doi.org/10.1016/j.juro.2012.07.032.

    Article  PubMed  Google Scholar 

  76. Schlomer BJ, Dugi DD, Valadez C, Morey AF. Correlation of penile and bulbospongiosus measurements: implications for artificial urinary sphincter cuff placement. J Urol. 2010;183(4):1474–8. https://doi.org/10.1016/j.juro.2009.12.032.

    Article  PubMed  Google Scholar 

  77. Cordon BH, Singla N, Singla AK. Artificial urinary sphincters for male stress urinary incontinence: current perspectives. Med Devices (Auckl). 2016;9:175–83. https://doi.org/10.2147/MDER.S93637.

    Article  Google Scholar 

  78. Saffarian A, Walsh K, Walsh IK, Stone AR. Urethral atrophy after artificial urinary sphincter placement: is cuff downsizing effective? J Urol. 2003;169(2):567–9. https://doi.org/10.1097/01.ju.0000046665.89269.f7.

    Article  PubMed  Google Scholar 

  79. Shakir NA, Fuchs JS, McKibben MJ, et al. Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success. Neurourol Urodyn. 2018;37(8):2632–7. https://doi.org/10.1002/nau.23703.

    Article  CAS  PubMed  Google Scholar 

  80. Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405–17. https://doi.org/10.1016/j.eururo.2012.05.045.

    Article  PubMed  Google Scholar 

  81. Hoffman D, Vijay V, Peng M, Sussman RD, Rosenblum N, Brucker BM, et al. Effect of Radiation on Male Stress Urinary Incontinence and the Role of Urodynamic Assessment. Urology. 2019;125:58–63. https://doi.org/10.1016/j.urology.2018.11.031.

    Article  PubMed  Google Scholar 

  82. Ko KJ, Lee CU, Kim TH, Suh YS, Lee K-S. Predictive factors of de novo overactive bladder after artificial urinary sphincter implantation in men with postprostatectomy incontinence. Urology. 2018;113:215–9. https://doi.org/10.1016/j.urology.2017.09.027.

    Article  PubMed  Google Scholar 

  83. Jahromi MS, Engle K, Furlong D, Guevara Méndez A, Gomez CS. Overactive bladder and urgency urinary incontinence in men undergoing artificial urinary sphincter placement. Neurourol Urodyn. April 2020;39:1489–93. https://doi.org/10.1002/nau.24378.

    Article  PubMed  Google Scholar 

  84. Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline Amendment 2019. J Urol. 2019;202(3):558–63. https://doi.org/10.1097/JU.0000000000000309.

    Article  PubMed  Google Scholar 

  85. Rahnama’i MS, Marcelissen TAT, Brierley B, Schurch B, de Vries P. Long-term compliance and results of intravesical botulinum toxin A injections in male patients. Neurourol Urodyn. 2017;36(7):1855–9. https://doi.org/10.1002/nau.23196.

    Article  CAS  PubMed  Google Scholar 

  86. Brucker BM, Demirtas A, Fong E, Kelly C, Nitti VW. Artificial urinary sphincter revision: the role of ultrasound. Urology. 2013;82(6):1424–8. https://doi.org/10.1016/j.urology.2013.07.064.

    Article  PubMed  Google Scholar 

  87. 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. https://doi.org/10.1016/j.juro.2015.05.075.

    Article  PubMed  Google Scholar 

  88. 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):32–5. https://doi.org/10.1111/bju.12207.

    Article  PubMed  Google Scholar 

  89. Yang DY, Linder BJ, Miller AR, Rangel LJ, Elliott DS. Can time to failure predict the faulty component in artificial urinary sphincter device malfunctions? Int J Urol. 2018;25(2):146–50. https://doi.org/10.1111/iju.13485.

    Article  PubMed  Google Scholar 

  90. 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. https://doi.org/10.1016/j.juro.2015.10.084.

    Article  PubMed  Google Scholar 

  91. Rozanski AT, Viers BR, Shakir NA, Pagliara TJ, Scott JM, Morey AF. Is removal of the pressure-regulating balloon necessary after artificial urinary sphincter cuff erosion? Urology. 2018;113:225–9. https://doi.org/10.1016/j.urology.2017.11.003.

    Article  PubMed  Google Scholar 

  92. Wiedemann L, Cornu J-N, 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. https://doi.org/10.1111/bju.12386.

    Article  PubMed  Google Scholar 

  93. Davenport MT, Akhtar AM, Shakir NA, et al. Comparison of 3.5 cm and transcorporal cuffs in high-risk artificial urinary sphincter populations. Transl Androl Urol. 2020;9(1):62–6. https://doi.org/10.21037/tau.2019.09.33.

    Article  PubMed  PubMed Central  Google Scholar 

  94. •• Ortiz NM, Wolfe AR, Baumgarten AS, et al. Artificial urinary sphincter cuff erosion “Heat Map” shows similar anatomic characteristics for transcorporal and standard approach. J Urol. 2020. https://doi.org/10.1097/JU.0000000000001148Demonstrates the lack of evidence to support transcorporal AUS placement.

  95. Maurer V, Dahlem R, Rosenbaum CM, Gild P, Vetterlein MW, Schüttfort V, et al. Distal double cuff vs transcorporal cuff as salvage options-a prospective analysis of different artificial urinary sphincter (AMS 800) Implantation Sites. Urology. 2019;133:234–9. https://doi.org/10.1016/j.urology.2019.07.018.

    Article  PubMed  Google Scholar 

  96. Maurer V, Marks P, Dahlem R, Rosenbaum CM, Meyer CP, Riechardt S, et al. Functional outcomes of artificial urinary sphincter implantation with distal bulbar double cuff in men with and without a history of external beam radiotherapy: an analysis of a prospective database. BJU Int. 2019;124(6):1040–6. https://doi.org/10.1111/bju.14882.

    Article  PubMed  Google Scholar 

  97. Yafi FA, DeLay KJ, Stewart C, Chiang J, Sangkum P, Hellstrom WJG. Device survival after primary implantation of an artificial urinary sphincter for male stress urinary incontinence. J Urol. 2017;197(3 Pt 1):759–65. https://doi.org/10.1016/j.juro.2016.08.107.

    Article  PubMed  Google Scholar 

  98. Ahyai SA, Ludwig TA, Dahlem R, Soave A, Rosenbaum C, Chun FKH, et al. Outcomes of single- vs double-cuff artificial urinary sphincter insertion in low- and high-risk profile male patients with severe stress urinary incontinence. BJU Int. 2016;118(4):625–32. https://doi.org/10.1111/bju.13449.

    Article  PubMed  Google Scholar 

  99. Manka MG, Wright EJ. Does use of a second cuff improve artificial urinary sphincter effectiveness? Evaluation using a comparative cadaver model. J Urol. 2015;194(6):1688–91. https://doi.org/10.1016/j.juro.2015.06.102.

    Article  PubMed  Google Scholar 

  100. 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 http://www.ncbi.nlm.nih.gov/pubmed/23783046. Accessed 20 Mar 2021.

  101. Pearlman AM, Rasper AM, Terlecki RP. Proof of concept: exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon. Investig Clin Urol. 2018;59(4):275–9. https://doi.org/10.4111/icu.2018.59.4.275.

    Article  PubMed  PubMed Central  Google Scholar 

  102. 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. https://doi.org/10.1111/bju.13324.

    Article  PubMed  Google Scholar 

  103. Moses RA, Keihani S, Craig JR, Basilius J, Hotaling JM, Lenherr SM, et al. Efficacy of pressure regulating balloon exchange in men with post artificial urinary sphincter persistent or recurrent stress urinary incontinence. Urology. 2019;123:252–7. https://doi.org/10.1016/j.urology.2018.07.052.

    Article  PubMed  Google Scholar 

  104. Srivastava A, Joice GA, Patel HD, Manka MG, Sopko NA, Wright EJ. Causes of artificial urinary sphincter failure and strategies for surgical revision: implications of device component survival. Eur Urol Focus. 2019;5(5):887–93. https://doi.org/10.1016/j.euf.2018.02.014.

    Article  PubMed  Google Scholar 

  105. Loh-Doyle JC, Nazemi A, Ashrafi A, Doumanian LR, Ginsberg DA, Boyd SD. Predictors of device-related complications after exchange of the pressure-regulating balloon in men with an artificial urinary sphincter. Urology. 2020;135:154–8. https://doi.org/10.1016/j.urology.2019.09.026.

    Article  PubMed  Google Scholar 

  106. Yarlagadda VK, Kilgore ML, Selph JP. Analysis of cost of component replacement versus entire device replacement during artificial urinary sphincter revision surgery. Neurourol Urodyn. 2018;37(6):1931–6. https://doi.org/10.1002/nau.23533.

    Article  PubMed  Google Scholar 

  107. •• Khouri RK, Baumgarten AS, Ortiz NM, et al. Pressure regulating balloon herniation: a correctable cause of artificial urinary sphincter malfunction. Urology. 2020. https://doi.org/10.1016/j.urology.2020.01.036Newly identifies a correctible cause of AUS malfunction.

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA

    Roger K. Khouri Jr, Benjamin M. Dropkin, Gregory A. Joice, Allen F. Morey & Steven J. Hudak

  2. Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA

    Nicolas M. Ortiz

  3. Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    Adam S. Baumgarten

Authors
  1. Roger K. Khouri Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas M. Ortiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin M. Dropkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory A. Joice
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adam S. Baumgarten
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Allen F. Morey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven J. Hudak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven J. Hudak.

Ethics declarations

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors were performed in accordance with all applicable ethical standards including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.

Conflict of Interest

Dr. Allen Morey receives honoraria for being a guest lecturer/meeting participant for Boston Scientific and Coloplast Corp.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Men's Health

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khouri, R.K., Ortiz, N.M., Dropkin, B.M. et al. Artificial Urinary Sphincter Complications: Risk Factors, Workup, and Clinical Approach. Curr Urol Rep 22, 30 (2021). https://doi.org/10.1007/s11934-021-01045-x

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11934-021-01045-x

Keywords

Search

Navigation