Treatment of urinary incontinence with an implantable prosthesis.

Experiences with various types of implantable urinary incontinence prostheses based on two principles, passive compression of the urethra (Kaufman) or artificial dynamic sphincter (Scott) are recounted. The series consists of 40 patients, 3 women and 37 men. The cause of incontinence was transurethral resection of the prostate or open prostatectomy in 29 cases, radical prostatectomy in 3 cases, neurogenic bladder in 7 cases and urethroplasty in 1 case. The success rate with the Kaufman prosthesis was 50% and that with the Scott artificial sphincter 91% with an average follow-up of 2 years. Mechanical complications or infection requiring surgical intervention occurred in 42% cases. Careful patient selection and meticulous surgical technique are essential. The artificial urinary sphincter (type AMS 800) appears to be the best treatment modality for urethral sphincter deficiency. In the selected cases the Kaufman prosthesis still has a place for the treatment of elderly men with poor cortical and manual control, making them incapable of managing the AMS 800 prosthesis.