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Urology. 2015 Jul;86(1):176-80. doi: 10.1016/j.urology.2015.04.023.

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

Author information

1
Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: jeswara@partners.org.
2
Department of Urology, Houston Methodist Hospital, Houston, TX.
3
Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO.

Abstract

OBJECTIVE:

To compare the results of various single-component artificial urinary sphincter (AUS) revision techniques for continued/recurrent stress urinary incontinence (SUI). Although AUS placement for male SUI has a high rate of success, revisions may be performed for mechanical failure of an isolated component or continued/recurrent SUI.

MATERIALS AND METHODS:

From 1993 to 2012, 90 AUS revisions including urethral cuff downsizing (19), pressure-regulating balloon replacement (18), cuff repositioning (11), or tandem cuff placement (42) were performed at 2 institutions. End points included reoperation, incontinence failure, and urethral erosion. The Kruskal-Wallis test was used to compare continuous variables, and the log-rank test was used to compare Kaplan-Meier curves.

RESULTS:

Mean age was 70.2 years, and median follow-up was 33.6 months. Median time to revision was 28.9 months. Tandem cuff placement was associated with a lower rate of incontinence failure (P = .02), whereas cuff repositioning was associated with a higher rate of incontinence failure (P = .02). An increased rate of mechanical failure was observed with cuff downsizing (P = .01). Among options for revision (1) cuff downsizing is associated with a higher rate of mechanical failure, and (2) cuff repositioning with the same size is associated with a higher rate of incontinence failure, whereas (3) tandem cuff placement is associated with a lower rate of recurrent SUI compared to other types of AUS revision.

CONCLUSION:

Cuff repositioning is associated with an increased rate of persistent incontinence after AUS revision whereas tandem cuff placement is associated with a lower rate of recurrent or persistent incontinence.

PMID:
26142602
DOI:
10.1016/j.urology.2015.04.023
[Indexed for MEDLINE]

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