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Efficacy of Pressure Regulating Balloon Exchange in Men With Post Artificial Urinary Sphincter Persistent or
Rachel A Moses1, Sorena Keihani1, James R Craig1
1Center for Reconstructive Urology, University of Utah, Salt Lake City, UT.
Urology
|September 12, 2018
Summary
Exchanging the pressure regulating balloon (PRB) in artificial urinary sphincter (AUS) devices can temporarily improve stress urinary incontinence (SUI). However, caution is advised for patients with prior radiation due to erosion risk, and revisions are common.
Area of Science:
- Urology
- Medical Devices
- Incontinence Management
Background:
- Persistent or recurrent stress urinary incontinence (SUI) after artificial urinary sphincter (AUS) placement presents a clinical challenge.
- Optimizing AUS device parameters, such as the pressure regulating balloon (PRB), may offer a solution without immediate surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of adjusting the PRB pressure (71-80 cm H2O) in patients experiencing persistent or recurrent SUI post-AUS implantation.
- To assess the impact of PRB exchange on incontinence symptoms and quality of life.
Main Methods:
- A retrospective review of patients with SUI following AUS implantation who underwent PRB replacement between 2011 and 2017.
- Exclusion criteria included urethral cuff malfunction, atrophy, stricture, or erosion.
- Outcomes measured included pad per day (PPD), Incontinence Symptom Index (ISI), Incontinence Quality of Life (I-QOL) scores, and device survival rates.
Main Results:
- Twenty-two patients (mean age 67 years) showed significant improvement in PPD (4.0 to 1.0, P=.01), ISI (21.6 to 16.3, P<.001), and I-QOL (15.2 to 7.2, P=.01) after PRB exchange.
- Three patients (14%) with prior radiation developed cuff erosion.
- The overall explantation/revision rate was 45%, with 68% and 41% device retention at 12 and 24 months, respectively.
Conclusions:
- PRB exchange can offer transient relief for post-AUS SUI when mechanical issues are absent.
- Prior radiation therapy increases the risk of urethral erosion.
- While often a temporizing measure requiring eventual revision, PRB exchange can delay more invasive procedures.
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