Does nocturnal deactivation of the artificial urinary sphincter lessen therisk of urethral atrophy?

Objectives. To compare nocturnal deactivation with nocturnal activation of the artificial urinary sphincter (AUS) to determine whether nocturnal deact ivation reduces the risk of urethral atrophy and subsequent recurrent incon tinence. To the best of our knowledge, no review comparing these two approa ches has been performed. Methods. At the Mayo Clinic, all patients are instructed to deactivate thei r AUS at night; at Baylor, all patients keep their AUS activated all the ti me. At each institution, a group of consecutive men with comparable severe urinary incontinence after radical retropubic prostatectomy were selected; 61 and 46 patients from the Mayo Clinic and Baylor, respectively, were avai lable for review. All Mayo Clinic patients strictly adhered to nocturnal de activation of their AUS and all 46 patients from Baylor kept their AUS acti vated at all times, except during voiding. Each patient was reviewed for th e long-term risk of subsequent reoperation, especially regarding recurrent incontinence due to urethral atrophy. Results. Seventeen (27.8%) of the 61 patients from Mayo (mean follow-up 40 months) required a repeated operation. Of the 17 AUS failures, 6 (35%) were due to urethral atrophy. Of the 46 patients from Baylor (mean follow-up 28 months), 16 (34.7%) required a repeated operation. Of the 16 AUS failures, 10 (62%) were due to urethral atrophy. Overall, the patients who nocturnal ly deactivated their AUS had a 10% risk of atrophy-related incontinence com pared with a 21% risk in the nocturnally activated group. Conclusions. Although not statistically significant, nocturnal deactivation appears to decrease the risk of urethral atrophy and recurrent incontinenc e (10% versus 21%). Nocturnal deactivation should be considered in men who are dry at night and have sufficient motivation to lessen the risk of ureth ral atrophy secondary to cuff compression. UROLOGY 57: 1051-1054, 2001. (C) 2001, Elsevier Science Inc.