THE FATE OF THE MODERN ARTIFICIAL URINARY SPHINCTER WITH A FOLLOW-UP OF MORE THAN 10 YEARS

Objective To assess the long-term outcome of patients who had an artif icial urinary sphincter (AUS) implanted between 10 and 15 years ago. P atients and methods Of 68 patients who had an AUS implanted more than 10 years ago, 61 were followed with sufficient detail for analysis. Th irty-four had a neuropathic bladder with sphincter dysfunction, 15 had post-prostatectomy sphincter weakness incontinence and 12 further pat ients had a variety of indications. Results The 61 patients experience d a total of 58 major complications and 49 have required at least one revision procedure. Currently eight (13%) patients are satisfactorily continent with their original AUS in situ and 29 others have a satisfa ctory revised AUS. Thus 37 of 61 (61%) are continent using an AUS at l east 10 years after first implantation. Eleven patients died and of th ese two had a satisfactory original AUS in situ and seven had successf ul revisions, In two patients the AUS failed but they were considered unfit for revision. Four female patients were continent and used inter mittent catheterization after the explantation of eroded AUS cuffs. In seven patients the AUS was abandoned; two of these patients reverted to condom drainage and five had continent or incontinent urinary diver sions fashioned. Thus, if those who died with a functioning AUS are in cluded, 46 of 61 (75%) achieved long-term continence with the AUS. Con clusions Despite the high complication and revision rate, these result s show that acceptable continence rates can be achieved in the long-te rm, particularly in the male neuropathic bladder and in those with pos tprostatectomy sphincter weakness. Many of the complications encounter ed may be less common with the current re-designed models of the AUS. However, it is essential that both surgeon and patient recognize and a ccept the likelihood of complications and revisions before using the A US. The continued use of the AUS where simpler methods of obtaining co ntinence are inappropriate remains justified.