PURPOSE: Durable success with the artificial urinary sphincter (AUS) is common but device revision and replacement are often needed for various reasons. We examined indications and outcomes following these secondary procedures with comparisons to outcomes after primary procedures. MATERIALS AND METHODS: The medical records of all patients undergoing primary and secondary bulbar urethral AUS implantation and revision from January 1990 to September 2002 were reviewed for various demographic and surgical variables. Female patients and males with bladder neck cuffs were excluded from study. RESULTS: Of 554 men undergoing AUS implantation or revision 119 (21.4%) underwent a total of 159 secondary procedures. Reasons for revision were mechanical failure in 31 cases (25.2%) and nonmechanical failure in 88 (73.9%). The latter included recurrent incontinence due to urethral atrophy in 63 cases (52.9%) and erosion in 21 (17.6%). Total device replacement was performed in 75 cases (47.2%). Of 119 patients undergoing secondary implantation 91 (76.5%) needed no additional surgical intervention, while 28 (23.5%) required a total of 40 surgical revisions for new mechanical (15 or 37.5%) and nonmechanical (25 or 62.5%) problems. Five-year durability outcomes for primary and secondary AUS implantation were comparable at 80% and 88%, respectively. Similarly excellent continence outcomes (0 to 1 pad daily) were noted in 90% and 82% of patients undergoing primary and secondary AUS implantation, respectively. Secondary and tertiary AUS revisions resulted in the restoration of baseline continence in 106 cases (89%). CONCLUSIONS: Our study suggests that outcomes for secondary AUS reimplantation are comparable to those of primary AUS implantation and salvage of a good outcome is always probable, even following multiple prior revisions and cuff erosion.
PURPOSE: Durable success with the artificial urinary sphincter (AUS) is common but device revision and replacement are often needed for various reasons. We examined indications and outcomes following these secondary procedures with comparisons to outcomes after primary procedures. MATERIALS AND METHODS: The medical records of all patients undergoing primary and secondary bulbar urethral AUS implantation and revision from January 1990 to September 2002 were reviewed for various demographic and surgical variables. Female patients and males with bladder neck cuffs were excluded from study. RESULTS: Of 554 men undergoing AUS implantation or revision 119 (21.4%) underwent a total of 159 secondary procedures. Reasons for revision were mechanical failure in 31 cases (25.2%) and nonmechanical failure in 88 (73.9%). The latter included recurrent incontinence due to urethral atrophy in 63 cases (52.9%) and erosion in 21 (17.6%). Total device replacement was performed in 75 cases (47.2%). Of 119 patients undergoing secondary implantation 91 (76.5%) needed no additional surgical intervention, while 28 (23.5%) required a total of 40 surgical revisions for new mechanical (15 or 37.5%) and nonmechanical (25 or 62.5%) problems. Five-year durability outcomes for primary and secondary AUS implantation were comparable at 80% and 88%, respectively. Similarly excellent continence outcomes (0 to 1 pad daily) were noted in 90% and 82% of patients undergoing primary and secondary AUS implantation, respectively. Secondary and tertiary AUS revisions resulted in the restoration of baseline continence in 106 cases (89%). CONCLUSIONS: Our study suggests that outcomes for secondary AUS reimplantation are comparable to those of primary AUS implantation and salvage of a good outcome is always probable, even following multiple prior revisions and cuff erosion.
Authors: Alexander Kretschmer; Alexander Buchner; Markus Grabbert; Christian G Stief; Micaela Pavlicek; Ricarda M Bauer Journal: World J Urol Date: 2015-08-08 Impact factor: 4.226
Authors: K-P Jünemann; H Palmtag; C Hampel; H Heidler; G Naumann; H Kölbl; C van der Horst; D Schultz-Lampel Journal: Urologe A Date: 2006-09 Impact factor: 0.639
Authors: Carlos Alberto Ricetto Sacomani; Stênio de Cássio Zequi; Walter Henriques da Costa; Bruno Santos Benigno; Rodrigo Sousa Madeira Campos; Wilson Bachega; Gustavo Cardoso Guimarães Journal: Int Braz J Urol Date: 2018 Jan-Feb Impact factor: 1.541