Insertion of artificial urinary sphincter with preservation of bulbospongiosus muscle in patients at risk for sphincter erosion: an assessment of patient satisfaction.

PURPOSE: To evaluate the safety and patient satisfaction following artificial urinary sphincter (AUS) placement with preservation of the bulbospongiosus muscle in patients at risk for erosion.
MATERIALS AND METHODS: The records of 67 patients who underwent AUS placement between the dates of 1997-2004 were reviewed. Patients were identified as being at risk for erosion if they had radiation therapy or previous erosion of an artificial sphincter. These patients underwent sphincter implantation emphasizing preservation of the bulbospongiosus muscle complex. Patients completed a phone interview and also returned an anonymous questionnaire containing the UDI-6, IIQ-7, PGI-I and a 10 point Likert scale to assess satisfaction.
RESULTS: 21 men were identified as high risk for erosion. Average daily pad usage preoperatively was 6.4. No urethral injuries or intraoperative complications occurred. Cuff size ranged from 4.0 to 5.0. Three revisions were necessary to downsize the cuff. At a mean follow-up of 35.8 months, 15/21 participated in the surveys. Two-thirds considered themselves "cured" or "greatly improved" following sphincter placement. The average daily pad usage decreased to 3.1. On a scale of 1-10, the average self-grading of satisfaction was 8. None of the patients felt the surgery was difficult to undergo, and all but 3 would repeat the procedure again. No patients developed erosion or infection of the device.
CONCLUSION: AUS placement can be safely done in patients at high risk for erosion by preserving the bulbospongiosus muscle complex. Long-term results are favorable with two-thirds of this difficult population highly satisfied with the result.