Advertisement

Artificial Urinary Sphincter: Patient Selection and Surgical Technique

  • Joseph J. PariserEmail author
  • Andrew J. Cohen
  • Alexandre M. Rosen
  • Gregory T. Bales
Chapter

Abstract

The artificial urinary sphincter (AUS) remains the gold standard for the treatment of male stress urinary incontinence and is associated with high satisfaction and low complication rates. Several revisions have been made to the initial designs leading to the current model, the AMS-800 (American Medical Systems, Minnetonka, MN) released in 1983. There have been a few additional modifications since that time as the technology has matured. Refining of the device, as well as surgeon experience, have allowed for consistency in clinical practice and improved outcomes. There are critical aspects of the preoperative workup for any patient considering AUS. Additionally, the surgical procedure itself and management of complications have been studied. In summary, the artificial urinary sphincter is a success story, and this chapter will focus on the essential aspects of patient selection and operative technique.

Keywords

Artificial urinary sphincter Incontinence Management Surgical technique Patient selection 

References

  1. 1.
    Scott FB, Bradley WE, Timm GW. Treatment of urinary incontinence by implantable prosthetic sphincter. Urology. 1973;1:252–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Foley FEB. An artificial sphincter; a new device and operation for control of enuresis and urinary incontinence. J Urol. 1947;58:250–9.PubMedGoogle Scholar
  3. 3.
    Carson CC. Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants. J Urol. 2004;171:1611–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Wilson SK, Zumbe J, Henry GD, et al. Infection reduction using antibiotic-coated inflatable penile prosthesis. Urology. 2007;70:337–40.CrossRefPubMedGoogle Scholar
  5. 5.
    De Cógáin MR, Elliott DS. The impact of an antibiotic coating on the artificial urinary sphincter infection rate. J Urol. 2013;190:113–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Lawson TM, Amos N, Bulgen D, et al. Minocycline-induced lupus: clinical features and response to rechallenge. Rheumatology (Oxford). 2001;40:329–35.CrossRefGoogle Scholar
  7. 7.
    Walsh PC, Marschke P, Ricker D, et al. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology. 2000;55:58–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA. 2000;283:354–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Menon M, Shrivastava A, Kaul S, et al. Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol. 2007;51:648–57. discussion 657–658.CrossRefPubMedGoogle Scholar
  10. 10.
    Comiter C. Surgery for postprostatectomy incontinence: which procedure for which patient? Nat Rev Urol. 2015;12:91–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Nitti VW, Mourtzinos A, Brucker BM, et al. Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU Pad Test Study. J Urol. 2014;192:836–42.CrossRefPubMedGoogle Scholar
  12. 12.
    Pepper J, Zhang A, Li R, et al. Usage and results of a mobile app for managing urinary incontinence. J Urol. 2014;193:1292–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim YH, Kattan MW, Boone TB. Bladder leak point pressure: the measure for sphincterotomy success in spinal cord injured patients with external detrusor-sphincter dyssynergia. J Urol. 1998;159:493–6. discussion 496–497.CrossRefPubMedGoogle Scholar
  14. 14.
    McGuire EJ, Woodside JR, Borden TA. Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia: a followup study. J Urol. 1983;129:823–6.PubMedGoogle Scholar
  15. 15.
    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;167:591–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Ravier E, Fassi-Fehri H, Crouzet S, et al. Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy. BJU Int. 2015;115:300–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Brant WO, Erickson BA, Elliott SP, et al. Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology. 2014;84:934–8.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fultz NH, Herzog AR. Self-reported social and emotional impact of urinary incontinence. J Am Geriatr Soc. 2001;49:892–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Moore KN, Schieman S, Ackerman T, et al. Assessing comfort, safety, and patient satisfaction with three commonly used penile compression devices. Urology. 2004;63:150–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Kumar A, Litt ER, Ballert KN, et al. Artificial urinary sphincter versus male sling for post-prostatectomy incontinence—what do patients choose? J Urol. 2009;181:1231–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Smiley DD, Umpierrez GE. Perioperative glucose control in the diabetic or nondiabetic patient. South Med J. 2006;99:580–9. quiz 590–591.CrossRefPubMedGoogle Scholar
  22. 22.
    Buchleitner AM, Martínez-Alonso M, Hernández M, et al. Perioperative glycaemic control for diabetic patients undergoing surgery. Cochrane Database Syst Rev. 2012;9, CD007315.Google Scholar
  23. 23.
    Mancini JG, Kizer WS, Jones LA, et al. Patient satisfaction after dual implantation of inflatable penile and artificial urinary sphincter prostheses. Urology. 2008;71:893–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Segal RL, Cabrini MR, Harris ED, et al. Combined inflatable penile prosthesis-artificial urinary sphincter implantation: no increased risk of adverse events compared to single or staged device implantation. J Urol. 2013;190:2183–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Msezane LP, Reynolds WS, Gofrit ON, et al. Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function. J Endourol. 2008;22:97–104.PubMedGoogle Scholar
  26. 26.
    Breyer BN, Davis CB, Cowan JE, et al. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int. 2010;106:1734–8.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Erickson BA, Meeks JJ, Roehl KA, et al. Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single-surgeon experience. BJU Int. 2009;104:1615–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Santucci R, Eisenberg L. Urethrotomy has a much lower success rate than previously reported. J Urol. 2010;183:1859–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Chung DE, Dillon B, Kurta J, et al. Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors. Can Urol Assoc J. 2012;2012:1–5.Google Scholar
  30. 30.
    Lai HH, Hsu EI, Boone TB. Urodynamic testing in evaluation of postradical prostatectomy incontinence before artificial urinary sphincter implantation. Urology. 2009;73:1264–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Thiel DD, Young PR, Broderick GA, et al. Do clinical or urodynamic parameters predict artificial urinary sphincter outcome in post-radical prostatectomy incontinence? Urology. 2007;69:315–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Weissbart SJ, Coutinho K, Chughtai B, et al. Characteristics and outcomes of men who fail to leak on intubated urodynamics prior to artificial urinary sphincter placement. Can J Urol. 2014;21:7560–4.PubMedGoogle Scholar
  33. 33.
    Saffarian A, Walsh K, Walsh IK, et al. Urethral atrophy after artificial urinary sphincter placement: is cuff downsizing effective? J Urol. 2003;169:567–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Couillard DR, Vapnek JM, Stone AR. Proximal artificial sphincter cuff repositioning for urethral atrophy incontinence. Urology. 1995;45:653–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Guralnick ML, Miller E, Toh KL, et al. Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol. 2002;167:2075–8. discussion 2079.CrossRefPubMedGoogle Scholar
  36. 36.
    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;170:1252–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Raj GV, Peterson AC, Toh KL, et al. Outcomes following revisions and secondary implantation of the artificial urinary sphincter. J Urol. 2005;173:1242–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Reynolds WS, Patel R, Msezane L, et al. Current use of artificial urinary sphincters in the United States. J Urol. 2007;178:578–83.CrossRefPubMedGoogle Scholar
  39. 39.
    Matsushita K, Chughtai BI, Maschino AC, et al. International variation in artificial urinary sphincter use. Urology. 2012;80:667–72.CrossRefPubMedGoogle Scholar
  40. 40.
    Poon SA, Silberstein JL, Savage C, et al. Surgical practice patterns for male urinary incontinence: analysis of case logs from certifying American urologists. J Urol. 2012;188:205–10.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Kim PH, Pinheiro LC, Atoria CL, et al. Trends in the use of incontinence procedures after radical prostatectomy: a population based analysis. J Urol. 2013;189:602–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Lai HH, Boone TB. The surgical learning curve of artificial urinary sphincter implantation: implications for prosthetic training and referral. J Urol. 2013;189:1437–43.CrossRefPubMedGoogle Scholar
  43. 43.
    Sandhu JS, Maschino AC, Vickers AJ. The surgical learning curve for artificial urinary sphincter procedures compared to typical surgeon experience. Eur Urol. 2011;60:1285–90.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Lee R, Te AE, Kaplan SA, et al. Temporal trends in adoption of and indications for the artificial urinary sphincter. J Urol. 2009;181:2622–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Almallah YZ, Grimsley SJS. A report of a regional service for post-prostatectomy urinary incontinence: a model for best practice? Ther Adv Urol. 2015;7:69–75.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Magera JS, Inman BA, Elliott DS. Does preoperative topical antimicrobial scrub reduce positive surgical site culture rates in men undergoing artificial urinary sphincter placement? J Urol. 2007;178:1328–32. discussion 1332.CrossRefPubMedGoogle Scholar
  47. 47.
    Tanner J, Norrie P and Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011;(11):CD004122.Google Scholar
  48. 48.
    Wolf JS, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179:1379–90.CrossRefPubMedGoogle Scholar
  49. 49.
    Darouiche RO, Wall MJ, Itani KMF, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362:18–26.CrossRefPubMedGoogle Scholar
  50. 50.
    Yeung LL, Grewal S, Bullock A, et al. A comparison of chlorhexidine-alcohol versus povidone-iodine for eliminating skin flora before genitourinary prosthetic surgery: a randomized controlled trial. J Urol. 2013;189:136–40.CrossRefPubMedGoogle Scholar
  51. 51.
    Wilson SK, Delk JR, Henry GD, et al. New surgical technique for sphincter urinary control system using upper transverse scrotal incision. J Urol. 2003;169:261–4.CrossRefPubMedGoogle Scholar
  52. 52.
    Henry GD, Graham SM, Cleves MA, et al. Perineal approach for artificial urinary sphincter implantation appears to control male stress incontinence better than the transscrotal approach. J Urol. 2008;179:1475–9. discussion 1479.CrossRefPubMedGoogle Scholar
  53. 53.
    Costa P, Mottet N, Rabut B, et al. The use of an artificial urinary sphincter in women with type III incontinence and a negative Marshall test. J Urol. 2001;165:1172–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Marqués Queimadelos A, Abascal García R, Muruamendiaraz Fernández V, et al. [Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach]. Arch Esp Urol. 1999;52:877–80.PubMedGoogle Scholar
  55. 55.
    Rouprêt M, Misraï V, Vaessen C, et al. Laparoscopic approach for artificial urinary sphincter implantation in women with intrinsic sphincter deficiency incontinence: a single-centre preliminary experience. Eur Urol. 2010;57:499–504.CrossRefPubMedGoogle Scholar
  56. 56.
    Yates DR, Phé V, Rouprêt M, et al. Robot-assisted laparoscopic artificial urinary sphincter insertion in men with neurogenic stress urinary incontinence. BJU Int. 2013;111:1175–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Fournier G, Callerot P, Thoulouzan M, et al. Robotic-assisted laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency incontinence: initial results. Urology. 2014;84:1094–8.CrossRefPubMedGoogle Scholar
  58. 58.
    Biardeau X, Rizk J, Marcelli F, et al. Robot-assisted laparoscopic approach for artificial urinary sphincter implantation in 11 women with urinary stress incontinence: surgical technique and initial experience. Eur Urol. 2015;67:937–42.CrossRefPubMedGoogle Scholar
  59. 59.
    Rothschild J, Chang Kit L, Seltz L, et al. Difference between urethral circumference and artificial urinary sphincter cuff size, and its effect on postoperative incontinence. J Urol. 2014;191:138–42.CrossRefPubMedGoogle Scholar
  60. 60.
    Margreiter M, Farr A, Sharma V, et al. Urethral buttressing in patients undergoing artificial urinary sphincter surgery. J Urol. 2013;189:1777–81.CrossRefPubMedGoogle Scholar
  61. 61.
    Simhan J, Morey AF, Singla N, et al. 3.5 cm Artificial urinary sphincter cuff erosion occurs predominantly in irradiated patients. J Urol. 2015;193:593–7.CrossRefPubMedGoogle Scholar
  62. 62.
    O’Connor RC, Lyon MB, Guralnick ML, et al. Long-term follow-up of single versus double cuff artificial urinary sphincter insertion for the treatment of severe postprostatectomy stress urinary incontinence. Urology. 2008;71:90–3.CrossRefPubMedGoogle Scholar
  63. 63.
    Vayleux B, Rigaud J, Luyckx F, et al. Female urinary incontinence and artificial urinary sphincter: study of efficacy and risk factors for failure and complications. Eur Urol. 2011;59:1048–53.CrossRefPubMedGoogle Scholar
  64. 64.
    Mandron E, Bryckaert P-E, Papatsoris AG. Laparoscopic artificial urinary sphincter implantation for female genuine stress urinary incontinence: technique and 4-year experience in 25 patients. BJU Int. 2010;106:1194–8. discussion 1198.CrossRefPubMedGoogle Scholar
  65. 65.
    Köhler TS, Benson A, Ost L, et al. Intentionally retained pressure-regulating balloon in artificial urinary sphincter revision. J Sex Med. 2013;10:2566–70.CrossRefPubMedGoogle Scholar
  66. 66.
    Cefalu CA, Deng X, Zhao LC, et al. Safety of the “drain and retain” option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience. Urology. 2013;82:1436–9.CrossRefPubMedGoogle Scholar
  67. 67.
    Ashley RA, Husmann DA. Artificial urinary sphincters placed after posterior urethral distraction injuries in children are at risk for erosion. J Urol. 2007;178:1813–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Smith PJ, Hudak SJ, Scott JF, et al. Transcorporal artificial urinary sphincter cuff placement is associated with a higher risk of postoperative urinary retention. Can J Urol. 2013;20:6773–7.PubMedGoogle Scholar
  69. 69.
    Seideman CA, Zhao LC, Hudak SJ, et al. Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion? Urology. 2013;82:943–6.CrossRefPubMedGoogle Scholar
  70. 70.
    Magera JS, Elliott DS. Artificial urinary sphincter infection: causative organisms in a contemporary series. J Urol. 2008;180:2475–8.CrossRefPubMedGoogle Scholar
  71. 71.
    Hajivassiliou CA. A review of the complications and results of implantation of the AMS artificial urinary sphincter. Eur Urol. 1999;35:36–44.CrossRefPubMedGoogle Scholar
  72. 72.
    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;159:1206–8.CrossRefPubMedGoogle Scholar
  73. 73.
    Lai HH, Hsu EI, Teh BS, et al. 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol. 2007;177:1021–5.CrossRefPubMedGoogle Scholar
  74. 74.
    Rozanski AT, Tausch TJ, Ramirez D, et al. Immediate urethral repair during explantation prevents stricture formation after artificial urinary sphincter cuff erosion. J Urol. 2014;192:442–6.CrossRefPubMedGoogle Scholar
  75. 75.
    Kim SP, Sarmast Z, Daignault S, et al. 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;179:1912–6.CrossRefPubMedGoogle Scholar
  76. 76.
    Gousse AE, Madjar S, Lambert MM, et al. Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: long-term subjective results. J Urol. 2001;166:1755–8.CrossRefPubMedGoogle Scholar
  77. 77.
    Venn SN, Greenwell TJ, Mundy AR. The long-term outcome of artificial urinary sphincters. J Urol. 2000;164:702–6. discussion 706–707.CrossRefPubMedGoogle Scholar
  78. 78.
    Jain R, Mitchell S, Laze J, et al. The effect of surgical intervention for stress urinary incontinence (UI) on post-prostatectomy UI during sexual activity. BJU Int. 2012;109:1208–12.CrossRefPubMedGoogle Scholar
  79. 79.
    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;191:734–8.CrossRefPubMedGoogle Scholar
  80. 80.
    Bates A, Martin R, Terry T. Complications following artificial urinary sphincter placement after radical prostatectomy and radiotherapy: a meta-analysis. BJU Int. 2015.Google Scholar
  81. 81.
    Girinsky T. Effects of ionizing radiation on the blood vessel wall. J Mal Vasc. 2000;25:321–4.PubMedGoogle Scholar
  82. 82.
    Martins FE, Boyd SD. Artificial urinary sphincter in patients following major pelvic surgery and/or radiotherapy: are they less favorable candidates? J Urol. 1995;153:1188–93.CrossRefPubMedGoogle Scholar
  83. 83.
    McGeady JB, McAninch JW, Truesdale MD, et al. Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol. 2014;192:1756–61.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Ngninkeu BN, van Heugen G, di Gregorio M, et al. Laparoscopic artificial urinary sphincter in women for type III incontinence: preliminary results. Eur Urol. 2005;47:793–7. discussion 797.CrossRefPubMedGoogle Scholar
  85. 85.
    Chung E, Cartmill RA. 25-year experience in the outcome of artificial urinary sphincter in the treatment of female urinary incontinence. BJU Int. 2010;106:1664–7.CrossRefPubMedGoogle Scholar
  86. 86.
    Costa P, Poinas G, Ben Naoum K, et al. Long-term results of artificial urinary sphincter for women with type III stress urinary incontinence. Eur Urol. 2013;63:753–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Joseph J. Pariser
    • 1
    Email author
  • Andrew J. Cohen
    • 1
  • Alexandre M. Rosen
    • 2
  • Gregory T. Bales
    • 1
  1. 1.Section of UrologyUniversity of Chicago MedicineChicagoUSA
  2. 2.Specialists in UrologyNaplesUSA

Personalised recommendations