Revision Techniques After Artificial Urinary Sphincter Failure in Men: Results From a Multicenter Study

Area of Science:

• Urology
• Medical Devices
• Surgical Outcomes

Background:

• Artificial urinary sphincter (AUS) placement is a common treatment for male stress urinary incontinence (SUI).
• Revisions are sometimes necessary due to mechanical failure or persistent/recurrent SUI.
• Various single-component revision techniques exist, each with potential drawbacks.

Purpose of the Study:

• To compare the effectiveness of different single-component artificial urinary sphincter (AUS) revision techniques.
• To identify which revision strategies minimize continued or recurrent stress urinary incontinence (SUI).

Main Methods:

• A retrospective review of 90 artificial urinary sphincter (AUS) revisions between 1993 and 2012.
• Techniques included cuff downsizing, pressure-regulating balloon replacement, cuff repositioning, and tandem cuff placement.
• Outcomes assessed were reoperation, incontinence failure, and urethral erosion, analyzed using Kruskal-Wallis and log-rank tests.

Main Results:

• Tandem cuff placement demonstrated a significantly lower rate of incontinence failure (P = .02).
• Cuff repositioning was associated with a higher rate of incontinence failure (P = .02).
• Cuff downsizing showed an increased rate of mechanical failure (P = .01).

Conclusions:

• Tandem cuff placement is associated with a lower rate of recurrent or persistent SUI after revision.
• Cuff repositioning is linked to a higher rate of persistent incontinence.
• Cuff downsizing is associated with increased mechanical failure rates.