Artificial Urinary Sphincter Cuff Size Predicts Outcome in Male Patients Treated for Stress Incontinence: Results of a Large Central European Multicenter Cohort Study

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Abstract

Purpose

The aim was to study the correlation between cuff size and outcome after implantation of an AMS 800 artificial urinary sphincter.

Methods

A total of 473 male patients with an AMS 800 sphincter implanted between 2012 and 2014 were analyzed in a retrospective multicenter cohort study performed as part of the Central European Debates on Male Incontinence (DOMINO) Project.

Results

Single cuffs were implanted in 54.5% and double cuffs in 45.5% of the patients. The cuffs used had a median circumference of 4.5 cm. Within a median follow of 18 months, urethral erosion occurred in 12.8% of the cases and was associated significantly more often with small cuff sizes (P<0.001). Multivariate analysis showed that, apart from cuff size (P=0.03), prior irradiation (P<0.001) and the penoscrotal approach (P=0.036) were associated with an increased erosion rate. Continence rate tended to be highest with median cuff sizes (4–5.5 cm).

Conclusions

Apart from irradiation and the penoscrotal approach, small cuff size is a risk factor for urethral erosion. Results are best with cuff sizes of 4.5–5.5 cm.

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Most cited references 21

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The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence.

Frank Van der Aa, Marcus J. Drake, George R Kasyan … (2013)

The artificial urinary sphincter (AUS) has historically been considered the gold standard for the surgical management of non-neurogenic stress urinary incontinence (SUI) in men. As new surgical alternatives attempt to offer alternatives to treat male SUI, a contemporary assessment of the evidence supporting the use of AUS appears mandatory for clinical decision making.

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Long-term Outcomes Following Artificial Urinary Sphincter Placement: An Analysis of 1082 Cases at Mayo Clinic.

Brian J Linder, Marcelino Rivera, Matthew J Ziegelmann … (2015)

To evaluate long-term device outcomes following primary artificial urinary sphincter (AUS) implantation.

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Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy.

Michael Guralnick, Elizabeth Miller, Khai-Lee Toh … (2002)

A distal cuff location is often required in patients undergoing artificial urinary sphincter reimplantation after previous erosion or in those requiring revision because of urethral atrophy at the original cuff site. Dissecting the urethra at a more distal site increases the risk of urethral injury and erosion, and often the urethral circumference is so small that a 4 cm. cuff is too large. We present a novel technique for distal cuff placement using transcorporal dissection that leaves corporal tunica albuginea on the dorsal surface of the urethra, allowing for its safer mobilization and adding to its bulk. We reviewed the charts of 31 men who underwent this technique and contacted 26 by telephone. The indications for distal transcorporal cuff placement varied. In 7 men with inadequate urethral coaptation with a 4 cm. proximal cuff at initial implantation a primary transcorporal tandem cuff was implanted distal. In 8 men persistent or recurrent incontinence despite a 4 cm. proximal cuff led to secondary distal reimplantation. Previous artificial urinary sphincter erosion and/or infection in 10 cases, previous urethral surgery at the optimal cuff site in 5 and radiation changes at the optimal cuff site in 1 led to selection of the more distal site and technique. Of the transcorporally placed cuffs 18 were 4 cm. and 13 were 4.5 cm. Preoperatively 5.2 pads were used daily. Of the 31 patients 27 were impotent preoperatively, 1 had normal erections, 1 had partial erections with the MUSE drug delivery system (Vivus, Inc., Menlo Park, California) and 2 had a previously placed penile prosthesis. At a mean followup of 17 months 26 of the 31 patients (84%) had occasional or no stress incontinence requiring 0 to 1 pad daily, 2 with pure urge incontinence used 1 to 2 pads daily and 3 had mixed incontinence requiring 0 to 3 pads daily. Of the 26 men surveyed 25 were very satisfied with the postoperative level of incontinence. Postoperatively erectile function deteriorated in 1 patient and was unchanged in the remainder. There was no erosion or infection of the transcorporally placed cuffs, although 3 were replaced for malfunction. This technique offers significant advantages in cases of revision. The technique protects the urethra from intraoperative dissection injury and decreases the risk of erosion because the urethra is buttressed at its vulnerable location. In addition, bulk is added to the urethra, allowing for better cuff sizing, which is usually a problem at this location where the urethra is small, thereby, improving continence in revised cases. Our success has recently led us to abandon tandem cuff placement altogether. There is a potential for deteriorating erectile function in potent men who undergo implantation in this fashion.

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Author and article information

Journal

Journal ID (nlm-ta): Int Neurourol J

Journal ID (iso-abbrev): Int Neurourol J

Journal ID (publisher-id): INJ

Title: International Neurourology Journal

Publisher: Korean Continence Society

ISSN (Print): 2093-4777

ISSN (Electronic): 2093-6931

Publication date (Print): September 2019

Publication date (Electronic): 30 September 2019

Volume: 23

Issue: 3

Pages: 219-225

Affiliations

[1 ]Department of Urology and Pediatric Urology, University Hospital of Muenster, Muenster, Germany

[2 ]Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany

[3 ]Department of Urology, Ludwig-Maximilians University Hospital, Großhadern Campus, Munich, Germany

[4 ]Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany

[5 ]Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany

[6 ]Department of Urology, Lueneburg Hospital, Lueneburg, Germany

[7 ]Department of Urology, Goettlicher Heiland Hospital of Vienna, Vienna, Austria

[8 ]Department of Urology, Bethel Evangelical Hospital, Bielefeld, Germany

[9 ]Department of Urology and Pediatric Urology, University Hospital of Kiel, Kiel, Germany

[10 ]Department of Urology, Diaconal Hospital of Stuttgart, Stuttgart, Germany

[11 ]Department of Urology and Pediatric Urology, University Hospital of Heidelberg, Heidelberg, Germany

[12 ]Department of Urology, Diaconal Hospital of Schwaebisch Hall, Schwaebisch Hall, Germany

[13 ]Department of Urology and Robotic Surgery, Prosper-Hospital, Recklinghausen, Germany

[14 ]Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany

[15 ]Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany

[16 ]Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany

[17 ]Department of Urology and Pediatric Urology, Helios Hospital Schwelm, Schwelm, Germany

[18 ]Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany

Author notes

Corresponding author: Fabian Queissert http://orcid.org/0000-0003-2486-2740 Department of Urology and Pediatric Urology, University Hospital of Muenster, Albert Schweitzer Campus 1, Muenster 48149, Germany E-mail: fabiqu@ 123456gmx.de / Tel: +49-251-83-49647 / Fax: +49-251-83-48348

Author information

Fabian Queissert http://orcid.org/0000-0003-2486-2740

Article

Publisher ID: inj-1938032-016

DOI: 10.5213/inj.1938032.016

PMC ID: 6790824

PubMed ID: 31607101

SO-VID: 0bc4e80d-97a9-43db-8169-727deba581be

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Artificial Urinary Sphincter Cuff Size Predicts Outcome in Male Patients Treated for Stress Incontinence: Results of a Large Central European Multicenter Cohort Study

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Abstract

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Methods

Results

Conclusions

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Karger: Neurology and Neuroscience

Most cited references 21

The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence.

Long-term Outcomes Following Artificial Urinary Sphincter Placement: An Analysis of 1082 Cases at Mayo Clinic.

Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy.

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