The artificial urinary sphincter appears to be efficacious for the treatment of male stress urinary incontinence, even in complex patients with histories of radiation therapy or urethral surgery.
In a retrospective chart review of 110 patients who had undergone AUS placement for stress incontinence between 1990 and 2006, the Virginia Mason team found 15 patients who had received radiation therapy and eight who had had multiple sphincters placed (two had a history of both). Six had their AUS removed because of urethral erosion.
Follow-up questionnaires assessing urinary control and patient satisfaction revealed that 76% were satisfied with the results of the procedure, while 71% saw significant decreases in the size and number of pads used, researchers reported at the Society for Urodynamics and Female Urology winter meeting.
"These complex patients with long-term follow-up do well with the artificial urinary sphincter," said first author Alvaro Lucioni, MD, an associate staff member in urology at Virginia Mason working with Fred Govier, MD, and colleagues. "It should be offered as a treatment option to them."
Urinary control in the study was assessed by the presence and quality of urinary leakage along with the type and number of pads used 3 months postoperatively and at present. Satisfaction, ease of use, and pain were measured on a 10-point scale at the same time intervals.
Fifteen AUS devices in the study were placed at outside institutions. That group included two patients with tandem cuffs, one with a transcorporeal cuff, and two with a combined AUS and inflatable penile prosthesis.
On a similar note, Dr. Lucioni and colleagues were pleasantly surprised when a single-cuff approach was found to work on two-thirds of the complex patients they saw.
"With many of those types of patients, you think you may have to do more than one cuff, or sometimes you have to put a cuff around the corpora to be more protective of the urethra," he said. "But in the majority of them, we just did a simple cuff."
Six of the 21 complex patients (29%) underwent one or more revisions of cuffs placed at Virginia Mason: two each for product malfunction and erosion/infection, and one each for atrophy and urinary retention.
That complication rate is not much higher than the 22% rate observed for all patients.
"So when we have a patient in a complex situation, we can tell them that while they have a little higher risk for complications, it's not significantly higher, and their satisfaction rate promises to be similar to that of other patients, as well," Dr. Lucioni said.