US Counterpoint to Chapter 14

Abstract

Proper patient selection is critical to a successful outcome for an artificial urinary sphincter (AUS). The first key issue we determine is if the urinary incontinence is the result of intrinsic sphincter deficiency. We perform a urodynamics study, as well as leak-point pressure studies to distinguish a bladder etiology from a urinary sphincter etiology. A pressure flow study and flexible cystoscopy are done to evaluate the bladder outlet for obstruction or urethral stricture disease. The presence of overactive or neurogenic bladder by urodynamics demands initial treatment with anticholinergic therapy before any consideration of AUS. Patients who receive an AUS should have good manual dexterity and enough intellectual capacity to properly work the device. This should be evaluated preoperatively.