POSTPROSTATECTOMY INCONTINENCE AND THE ARTIFICIAL URINARY SPHINCTER -A LONG-TERM STUDY OF PATIENT SATISFACTION AND CRITERIA FOR SUCCESS

Purpose: We investigated patient satisfaction with the artificial urin ary sphincter and established criteria for a successful outcome by inq uiring about patient perceived satisfaction, continence achieved and c omparison with the surgeon office records. Materials and Methods: Duri ng 9 years 65 patients with post-prostatectomy incontinence underwent placement of the AMS800 artificial urinary sphincter. Review of chart s and a telephone questionnaire were conducted to determine patient pe rceived satisfaction. Results: A total of 50 patients participated in the survey. Median followup was 23.4 months. Preoperative incontinence was severe. Of the patients 90% reported continuous leakage, and 70% wore an average of 6 diapers and 24% wore an average of 7.4 pads daily . The long-term complete continence rate was 20%. Of the patients with wetness 55% had leakage of a few drops daily and 22% had leakage of l ess than a teaspoon. Of all patients 50% had leakage daily, 24% had le akage 1 or more times a week and wore an average of 1.5 pads per day, and 6% reported changing clothes due to wetness. A total of 90% of the patients reported satisfaction with the artificial urinary sphincter and 96% stated that they would recommend or had recommended the artifi cial urinary sphincter to a friend. In retrospect, 92% of the patients would have the artificial urinary sphincter placed again, 90% of thos e undergoing revision reported no change in satisfaction and 14% repor ted improved sexual activity. Conclusions: Patient satisfaction with t he artificial urinary sphincter for post-prostatectomy incontinence is uniformly high. Although postoperative continence was not 100%, relat ive improvement in continence was the most significant factor affectin g patient perceived outcome. Using these parameters criteria for a suc cessful outcome can be established, and patient concerns regarding the artificial urinary sphincter can be dispelled.