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Management of artificial urinary sphincter dysfunction.

Abstract：

OBJECTIVE:The long-term outcome of artificial urinary sphincter (AUS) is unpredictable because of, among others, the risk of breakdown of one of its components. Our objective was to define a strategy for an accurate diagnosis and an appropriate management of these problems. PATIENTS AND METHODS:From 1985 to 2000, 298 AUS (AMS 800) have been implanted in 288 patients aged 53 +/- 21 years (8 to 87 years). There were 130 women with urinary stress incontinence, 84 with neurological disorders, 76 following prostatic surgery and 8 for other reasons. Diagnosis was often done following the recurrence of urinary incontinence. The pump was systematically checked and all patients underwent radiographic and urodynamic studies. We have systematically looked for the defective component in order to avoid replacing the entire sphincter. RESULTS:Fifty-five patients (19%) have been re-operated on after a median follow-up of 23 months (11 days-10 years): Thirty-two only once, 20 twice and 3 patients 4 times. There were 55 depressurizations, 18 device dysfunctions without depressurization and 11 removals of the sphincter. Among the 55 depressurizations, 30 were related to a perforation of one component, 24 to a functional but insufficient sphincter and 1 to tubing disconnection. In forty cases, only one component of the AUS was replaced while 2 components were replaced in 10 cases, the entire AUS in 4 cases and no component in one case. CONCLUSION:The longer the follow-up the greater is the probability of a dysfunction. We systematically continue to look for the defective component and just to replace it instead of the entire sphincter.

journal_name

Eur Urol

journal_title

European urology

authors

Maillet F,Buzelin JM,Bouchot O,Karam G

doi

10.1016/j.eururo.2004.01.017

keywords:

subject

Has Abstract

pub_date

2004-08-01 00:00:00

pages

241-5; discussion 246

issue

2

eissn

0302-2838

issn

1873-7560

pii

S0302283804000582

journal_volume

46

pub_type

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