The use of an artificial urinary sphincter in women with type III incontinence and a negative Marshall test

Purpose: We evaluate the efficacy of the AIMS 800 double dagger artificial urinary sphincter in women with type III incontinence. Materials and Methods: We enrolled 207 women with genuine stress incontinen ce due to intrinsic sphincter deficiency. Primary inclusion criterion was a negative Marshall test. A modified surgical procedure was used to implant the AMS 800 through an abdominal approach, with placement of the cuff aroun d the bladder neck between the periurethral fascia and vagina. Followup dat a were available for 206 women, including 179 with nonneurogenic and 27 wit h neurogenic bladders (mean followup 3.9 years). Results: There were 12 (5.9%) explantations due to the prosthesis either th rough an erosion, extrusion or both that were necessary. The only significa nt risk factor for explantation was perioperative injury. This injury resul ted in 8 explantations in 49 patients compared with 4 in 155 who did not ha ve such injuries (p = 0.0016). Of the 190 patients with working devices con tinence was achieved in 88.7% (49 of 168) and 81.8% (18 of 22) of those wit h nonneurogenic and neurogenic bladders, respectively. Social continence (s light leakage but no pad use) was reported by 7.1% (13 of 168) and 9.1% (2 of 22) of patients in the nonneurogenic and neurogenic groups, respectively . The remaining patients reported leakage and pad use. Conclusions: The AMS 800 can be used successfully to treat women with genui ne stress incontinence due to intrinsic sphincter deficiency. The modified surgical approach resulted in fewer perioperative injuries and, consequentl y, a low explantation rate. Women with genuine stress incontinence, a Tow u rethral closure pressure and negative Marshall test indicating severe intri nsic sphincter deficiency are potential candidates for artificial urinary s phincter implantation.