Artificial sphincter

This review examines the evidence to date, and summarizes the indications, technical and surgical aspects, risk factors and challenges of peer-reviewed artificial sphincters in the treatment of male stress urinary incontinence (SUI).

Although new devices have been introduced, the AMS 800 continues to be the most implanted and reported on artificial urinary sphincter (AUS) worldwide. Although the AUS seems to be effective in the treatment of neurogenic and non-neurogenic SUI, large randomized, controlled trials are missing. Urethral erosion, atrophy and infection are the primary reported risk factors for high revision rates with most surgeons performing less than three implants per year. Transurethral catheterization has been identified as the main risk factor for urethral erosion. Surgical modifications have been reported with good outcomes. The perineal implantation of a single cuff continues to be the most frequently used procedure, but transcorporal implantation may be helpful in salvage situations. Recent device improvements, such as the antibiotic coating, do not seem to influence infection rates. New devices continued to be introduced; however, short-term and long-term results in larger studies are required. Patients with concomitant SUI and erectile dysfunction have the option of a synchronous implantation with an AUS and penile prosthesis with similar results.

Despite the low level of evidence, the AUS is well tolerated, effective and recommended for male SUI treatment in urological guidelines. Implantation in high-volume experienced centers is strongly recommended. Comprehensive patient counselling is required to prevent complications and necessary revisions.