Reconstructive UrologyLong-term Outcomes After Primary Failures of Artificial Urinary Sphincter Implantation
Section snippets
Material and Methods
This is a retrospective review of our Institutional Review Board–approved, single-institution reconstructive urology database over the last 25 years. We excluded female patients, children, and male patients with bladder neck cuffs or follow-up of less than 6 months at our institution; thus we identified 149 adult male patients who underwent 318 primary and additional AUS procedures from June 1985 to September 2010. We collected data regarding patient demographics, comorbidities, operative
Patient and Procedure Characteristics
Table 1 illustrates the demographics of our patient population and the characteristics of their procedures. Median follow-up was 52 months (range, 6-250 months), but was shortest for patients undergoing robotic prostatectomy (17.9 months), given the more contemporary use of this modality. Of 149 patients, 70 (47%) patients had a primary implantation only, with no subsequent procedure required. A total of 31 (20.8%) had 2 procedures, 26 (17.4%) had 3, and 22 (14.8%) had 4 or more; overall,
Comment
More than half of patients undergoing initial AUS placement will require at least 1 additional procedure, most likely a revision. Historically, we were most likely to revise the reservoir by upsizing the pressure, especially in cases of recurrent incontinence without obvious mechanical malfunction or erosion. This was particularly true before the introduction of the 3.5 cm cuff, thus prohibiting further downsizing in patients with a 4-cm cuff. We also preferred reservoir upsizing over placement
Conclusions
At our tertiary care center, more than half of patients with an AUS will require at least 1 additional procedure, most likely a revision. Subsequent procedures beyond the implantation are performed for a variety of reasons, including incontinence, malfunction, and infection or erosion. Median time to first revision or explantation is just less than 2 years. Previous radiation and myocardial infarction are linked to erosion; obesity is linked to mechanical malfunction. Appropriate preoperative
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