Elsevier

Urology

Volume 79, Issue 4, April 2012, Pages 922-928
Urology

Reconstructive Urology
Long-term Outcomes After Primary Failures of Artificial Urinary Sphincter Implantation

https://doi.org/10.1016/j.urology.2011.11.051Get rights and content

Objectives

To assess our institutional outcomes after primary artificial urinary sphincter (AUS) failures.

Methods

From 1985 to 2010, a total of 149 patients underwent 318 primary and additional AUS procedures. We classified additional procedures as revisions, replacements, or explantations.

Results

At a median of 52 months (range, 6-250 months), 53% of patients had required at least 1 additional procedure beyond their initial implantation. These included 106 (63%) revisions, 42 (24.9%) explantations, and 21 (12.4%) replacements. The most common revision was reservoir upsizing (37/106). Reasons for first revision included recurrent incontinence (56.7%), mechanical malfunction (22%), and infection or erosion (18.6%). Explantations were performed primarily for infection and erosion (64.3%). Median time to first revision was 20.1 months (range, 0.1-173 months) after implantation, with a median of 9.5 months (range, 1-102 months) between revisions. Explantation occurred at a median of 22 months (range, 1-221 months) after implant, and subsequent replacement at a median of 33.6 months (range, 2-138 months). At 5 years, 28/83 (33.7%) patients had undergone no additional procedures. Patients with previous radiation were more likely to experience infection (P = .03; OR 3.99; 95% CI 1.03-15.42). Patients with previous myocardial infarction were more likely to experience erosion (P = .04; OR 2.29; 95% CI 1.05-5.02), and obese patients were more likely to experience mechanical malfunction (P = .04; OR 2.62; 95% CI 1.07-6.4).

Conclusions

More than half of patients with an AUS will require additional procedures, most likely revision. Radiation, previous myocardial infarction, and obesity are linked to complications. Median time to first revision or explantation is slightly less than 2 years, indicating that long-term follow-up is required after initial 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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