Management of persistent or recurrent urinary incontinence after placement of artificial urinary sphincter

A rational systematic approach is presented in the evaluation of 14 men with persistent or recurrent urinary incontinence after placement of the AMS800 artificial urinary sphincter. Mechanical malfunctions, including device leaks and control assembly malfunctions, may often be discovered with physical examination and radiographic evaluations. Nonmechanical malfunctions, such as cuff erosion, inadequate cuff compression and functional urethral atrophy, can be diagnosed with perfusion sphincterometry, urethroscopy and a filling cystometrogram, all combined in 1 simplified technique. With the presented algorithm the over-all success rate after 1 revision was 82%. Mechanical malfunctions appear to have a better revision rate of success than nonmechanical malfunctions (100% versus 71.5%, respectively).