[Surgical therapy of urinary incontinence in the male]

From 1973 to 1990 a total of 340 male patients suffering from incontinence of various etiologies were treated by implantation of an artificial urinary sphincter. In 165 patients the sphincter was placed at the bladder neck, while 175 needed an implantation at the bulbous urethra. Because of the better results with regard to continence, we prefer the bladder neck implantation. The youngest patient treated was 12 years old and the oldest, 91. Most of the patients were between 40 and 80 years old. The highest continence rates were achieved in patients with postprostatectomy urinary incontinence. Among those with a bladder neck implant continence was achieved in 93.3% of all cases, while 87.4% of those with an artificial sphincter at the bulbous urethra achieved continence. The mechanical complication rate was low with 7.05%, whereas tissue-related complications occurred in a total of 25.3% of cases. Revision was necessary in 30.9% of cases during the first few years after implantation; it was striking that the incidence of revision fell dramatically 1 year after implantation. This is also true for any second revision, which usually becomes necessary within the first year after the first revision. In total, however, two-thirds of the patients do not require revision during the first 5 years. These data show that the implantation of an artificial sphincter is the safest and most successful method for the treatment of urinary incontinence in the male. This method is superior to all other operative treatments and should be considered the first-line treatment, especially in post-prostatectomy urinary incontinence.