Managing urinary incontinence post artificial urinary sphincter implantation: key learnings and the way forward
Dr Fong Voon Yen (1), Dr Warren Lo Hwa Loon (1)
(1) Malaysia Urology Association, Kuala Lumpur, Malaysia
The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe, reliable and gold standard treatment for post prostatectomy stress urinary incontinence (SUI).Despite impressive rates of initial success for restoration of continence, revisions may be performed for mechanical failure of an isolated component or recurrent SUI.Our objective aim to define a strategy for an accurate diagnosis and an appropriate management of these problems.
From year 2010 to 2019, there were total of 5 patients returned with recurrent SUI after AUS installation. Mean age was about 70 years and all of them had undergone robotic prostatectomy in previous years. We had systematically looked for the defective component in order to avoid replacing the entire sphincter. Diagnosis was often determined following radiographic and urodynamic studies.
Among the 5 patients, one patient had suffered from malfunction cuff in which we had put in double cuffs to overcome incontinence.We had changed the cuff size of a patient who had developed urethral atrophy and also performed revision of cuff for another patient who had inappropriate cuff size.One patient returned with cuff migration and we had repositioned the cuff.Among all, only one patient developed sepsis owing to infected AUS and we had decided to change the whole set of AUS.All patients recovered well after the salvage procedures.
AUS remains an excellent option for surgical correction of moderate to severe post prostatectomy SUI. Detailed preoperative evaluation and patient selection are critical. The challenge of downstream recurrent SUI after AUS can be effectively managed for most patients with a structured approach.