Use of the Artificial Urinary Sphincter in Women

Persistent urinary incontinence after failed surgical repair can be successfully treated with the artificial urinary sphincter. The English literature was reviewed from 1985 to 1996. Eleven articles and abstracts addressing placement of the artificial urinary sphincter in women were identified. Discussion includes two operative techniques. Success rates were in the range of 91%–99%. Erosion rates were 7%–29%. The artificial urinary sphincter is an effective treatment for women failing other procedures. Appropriate work-up and diagnosis for type III stress urinary incontinence is crucial.     

Long-Term Results of Artificial Urinary Sphincter for Women with Type III Stress Urinary Incontinence

Background

The use of the artificial urinary sphincter (AUS) in women is limited.

Objective

To analyse long-term results and mechanical survival of the AUS (AMS 800; American Medical Systems, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD).

Design, setting, and participants

Women with SUI who were treated between January 1987 and March 2007 were included in this prospective study. Only women with low closure pressure at urethral profile and negative continence tests, indicators of severe ISD, were included.

Interventions

An AUS was implanted. The surgical technique was modified in 1999, involving opening the endopelvic fascia on both sides and dissection in contact with the vaginal wall.

Outcome measurements and statistical analysis

Assessment of complications was made pre- and postoperatively and continence status was based on pad usage. Kaplan-Meier survival curves were used to calculate mechanical survival of the device. Student t test and the chi-square test were used to compare continence and complication rates.

Results and limitations

A total of 376 AUS were implanted in 344 patients, whose mean age was 57 yr. The mean follow-up, plus or minus standard deviation, was 9.6 ± 4.0 yr. At last follow-up, postoperative continence rates, assessed as fully continent (no leakage), socially incontinent (some drops but no pad), or incontinent (one pad or more), were 85.6%, 8.8%, and 5.6%, respectively. The 3-, 5-, and 10-yr device survival rates were 92.0%, 88.6%, and 69.2%, respectively. The mean mechanical survival was 176 mo (14.7 yr). Three risk factors for AUS survival were the number of previous incontinence surgeries, the presence of neurogenic bladder, and simultaneous augmentation enterocystoplasty. Principal limitation of the study is the absence of validated incontinence questionnaire.

Conclusions

The AUS provides excellent outcome in women with ISD, with low explantation rate and very good device survival.     

The Artificial Urinary Sphincter for Post-Radical Prostatectomy Incontinence: Impact on Urinary Symptoms and Quality of Life

Purpose

We addressed the impact of the artificial urinary sphincter on the health related quality of life and urinary symptoms in men with post-radical prostatectomy incontinence.

Materials and Methods

A total of 30 men with an AMS800* artificial urinary sphincter following radical prostatectomy responded to a questionnaire dealing with the impact of the symptoms on activities of daily living and quality of life. We compared these results to those of 31 patients who underwent radical prostatectomy but did not require an artificial urinary sphincter.*American Medical Systems, Minnetonka, Minnesota.

Results

Incontinence was minimal in both groups. Irritative symptoms were noted in the artificial urinary sphincter group, as well as some impairment in activities of daily living. No significant differences were noted with respect to quality of life.

Conclusions

The artificial urinary sphincter is an effective form of therapy for post-radical prostatectomy incontinence but irritative voiding symptoms occur, which tend to limit activities of daily living.     

Laparoscopic Approach for Artificial Urinary Sphincter Implantation in Women with Intrinsic Sphincter Deficiency Incontinence: A Single-Centre Preliminary Experience

Background

Implantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI).

Objective

To assess the early functional outcome after laparoscopic placement of an AUS in women.

Design, setting, and participants

Twelve women with type 3 SUI underwent a laparoscopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures.

Intervention

The AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina.

Measurements

Perioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter.

Results and limitations

The mean age of subjects was 56.7 ± 12 yr (33–78). The mean body mass index was 24 ± 2.3 (20–25). The mean preoperative closure pressure was 22 ± 10.9 cmH₂O (4–35). The mean operative time was 181 ± 39 min [110–240]. Intraoperative complications occurred in three women (25%), with bladder (n = 2) and vaginal (n = 2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7 ± 2.3 d (3–11). The bladder catheter was removed after a mean time of 10 ± 8 d (2–30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4–14 wk after implantation. Mean follow-up was 12.1 ± 8 mo (5.2–27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up.

Conclusions

AUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy.