OBJECTIVES: Recurrent incontinence after implantation of an artificial urinary sphincter (AUS) may be due to urethral atrophy. Treatment options consist of decreasing the cuff size, increasing the balloon pressure, implanting a double-cuff system, or proximal cuff repositioning. The first three options may increase the risk of erosion. Increasing the balloon pressure does not effectively increase cuff pressure. This article demonstrates that proximal cuff repositioning is a safe, simple, and effective technique in the management of recurrent incontinence as a result of a loss of cuff compression due to urethral atrophy. METHODS: Six patients underwent proximal repositioning of the AUS (AS-800) cuff for recurrent post-prostatectomy incontinence. Urethral atrophy was determined by a thorough systematic evaluation. A detailed description of the surgical technique is provided. RESULTS: Five of 6 patients (83%) had significant improvement in incontinence with an average follow-up of greater than 1 year. In 1 patient with no improvement, preoperative urodynamics revealed poor detrusor compliance in addition to sphincter weakness due to loss of cuff compression. CONCLUSIONS: Proximal cuff repositioning on the bulbar urethra is an effective, safe, and simple technique in the management of recurrent incontinence due to urethral atrophy and may minimize the risk of erosion.
OBJECTIVES: Recurrent incontinence after implantation of an artificial urinary sphincter (AUS) may be due to urethral atrophy. Treatment options consist of decreasing the cuff size, increasing the balloon pressure, implanting a double-cuff system, or proximal cuff repositioning. The first three options may increase the risk of erosion. Increasing the balloon pressure does not effectively increase cuff pressure. This article demonstrates that proximal cuff repositioning is a safe, simple, and effective technique in the management of recurrent incontinence as a result of a loss of cuff compression due to urethral atrophy. METHODS: Six patients underwent proximal repositioning of the AUS (AS-800) cuff for recurrent post-prostatectomy incontinence. Urethral atrophy was determined by a thorough systematic evaluation. A detailed description of the surgical technique is provided. RESULTS: Five of 6 patients (83%) had significant improvement in incontinence with an average follow-up of greater than 1 year. In 1 patient with no improvement, preoperative urodynamics revealed poor detrusor compliance in addition to sphincter weakness due to loss of cuff compression. CONCLUSIONS: Proximal cuff repositioning on the bulbar urethra is an effective, safe, and simple technique in the management of recurrent incontinence due to urethral atrophy and may minimize the risk of erosion.
Authors: Brian J Linder; Boyd R Viers; Matthew J Ziegelmann; Marcelino E Rivera; Daniel S Elliott Journal: Int Braz J Urol Date: 2017 Mar-Apr Impact factor: 1.541