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Does Use of a Second Cuff Improve Artificial Urinary Sphincter Effectiveness? Evaluation Using a Comparative Cadaver

Madeleine G Manka1, E James Wright1

  • 1The Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of Urology
|July 14, 2015
PubMed
Summary

A tandem cuff for artificial urinary sphincters did not improve leak point pressure in cadavers. Urethral circumference correlated with pressure, suggesting cuff placement, not tandem design, impacts efficacy for male stress incontinence.

Keywords:
artificialcadaverurinary bladderurinary incontinenceurinary sphincterurodynamics

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Area of Science:

  • Urology
  • Biomedical Engineering
  • Anatomy

Background:

  • Artificial urinary sphincter (AUS) is the gold standard for male stress incontinence.
  • The efficacy of a tandem cuff (two cuffs) versus a single cuff is debated.
  • Evidence supporting tandem cuff benefits is limited.

Purpose of the Study:

  • To compare the functionality of single vs. tandem urethral cuffs in an artificial urinary sphincter model.
  • To evaluate the impact of cuff placement on retrograde leak point pressure.

Main Methods:

  • Cadaveric dissection of the bulbar urethra.
  • Measurement of urethral circumference at distal and proximal sites.
  • Placement and testing of single (distal/proximal) and tandem cuffs.
  • Retrograde leak point pressure (RLPP) measurement.

Main Results:

  • Mean RLPP was similar for distal (73.5 cm H2O), proximal (77.75 cm H2O), and tandem cuffs (79.25 cm H2O).
  • Proximal bulbar urethral circumference (5.83 cm) was significantly larger than distal (4.78 cm).
  • A strong positive correlation (rs=0.5) was observed between urethral circumference and RLPP.

Conclusions:

  • Tandem cuffs did not demonstrate improved RLPP compared to single cuffs in this model.
  • Increasing urethral circumference positively correlates with higher RLPP.
  • Perceived benefits of tandem cuffs may be attributed to more proximal placement of one cuff.