Long‐term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence

• Published in: BJU international Vol. 115; no. 6; pp. 951 - 957
• Main Authors: Léon, Priscilla, Chartier‐Kastler, Emmanuel, Rouprêt, Morgan, Ambrogi, Vanina, Mozer, Pierre, Phé, Véronique
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-06-2015; Wiley
• Subjects: Aged; Device Removal; Human health and pathology; Humans; Kaplan-Meier Estimate; Life Sciences; Male; Middle Aged; outcomes; Postoperative Complications - etiology; Prosthesis Implantation - adverse effects; Prosthesis Implantation - methods; survival; Treatment Outcome; Urinary incontinence; Urinary Incontinence, Stress - surgery; urinary sphincter; Urinary Sphincter, Artificial; Urologic Surgical Procedures, Male - adverse effects; Urologic Surgical Procedures, Male - methods; Urology and Nephrology; urinary sphincter; outcomes; urinary incontinence; survival
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.12848

Objective
To evaluate long‐term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery.
Patients and Methods
Men who had undergone placement of an AUS (American Medical Systems AMS 800®) between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow‐up. Kaplan–Meier survival curves estimated the survival rate of the device without needing explantation or revision.
Results
In all, 57 consecutive patients were included with a median (interquartile range, IQR) age of 69 (64–72) years. The median (IQR) duration of follow‐up was 15 (8.25–19.75) years. At the end of follow‐up, 25 patients (43.8%) still had their primary AUS. The AUS was explanted in nine men because of erosion (seven) and infection (two). Survival rates, without AUS explantation, were 87%, 87%, 80%, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59%, 28%, 15%, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow‐up, in intention‐to‐treat analysis, 77.2% of patients were continent.
Conclusion
In the long term (>10 years) the AMS 800 can offer a high rate of continence to men with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.