Artificial urinary sphincters around intestinal segments--are they safe?

Area of Science:

• Urology
• Prosthetic Devices
• Reconstructive Surgery

Background:

• Urinary and faecal incontinence pose significant challenges.
• Artificial urinary sphincters (AUS) are prosthetic devices used to manage incontinence.
• Previous applications of AUS have focused on bladder neck or urethral erosion.

Purpose of the Study:

• To evaluate the efficacy and safety of implanting artificial urinary sphincters (AUS) around intestinal segments for urinary and faecal continence.
• To assess AUS performance in cases of bladder neck or urethral erosion and for continent diversion.

Main Methods:

• Artificial urinary sphincters (AUS) were surgically implanted around intestinal segments in 9 patients.
• Cuff placement included cystoplasty (n=6), parastomal (n=2), and rectal (n=1).
• Outcomes assessed included urinary/faecal continence, complications, and need for catheterisation or explantation.

Main Results:

• Four of 8 patients achieved complete urinary dryness, one with self-intermittent catheterisation (SIC).
• One patient experienced mild stress incontinence, and one cuff eroded at 8 months.
• One of two continent diversion cases required AUS explantation due to metabolic acidosis; the rectal cuff was explanted due to faecal impaction.

Conclusions:

• Implanting an AUS around a cystoplasty is a viable last resort for urinary continence, with risks comparable to bladder neck implantation.
• The current artificial urinary sphincter model is not suitable for treating faecal incontinence.
• The use of AUS for continent diversion is limited due to the availability of effective non-prosthetic techniques.