Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: Actuarial analysis

Purpose: We determined the actuarial revision rate for artificial urinary s phincters implanted in patients who were incontinent after radical prostate ctomy. Materials and Methods: We reviewed the records of 70 consecutive patients w ho were incontinent after radical prostatectomy and who underwent primary a rtificial urinary sphincter implantation at the University of Michigan betw een 1984 and 1999. Questionnaires were mailed to all patients with an indwe lling device, and telephone calls were placed to those who did not respond to the mailing. Information about surgical revision and current continence status was obtained from chart review and questionnaire response. The Kapla n-Meier curves for actuarial freedom from operative revision were construct ed. Results: Of the 66 patients with available postoperative data 24 (36%) requ ired reoperation at a mean followup of 41 months. The 5-year actuarial rate for freedom from any operative revision was 50%, and the corresponding rat e for cuff revision was 60%. A single operative revision did not predispose the patient to further revision. Questionnaire data indicated a continence rate of 80% (range 0 to 2 pads). Conclusions: Approximately half of the patients who were incontinent after radical prostatectomy may expect to undergo operative revision within 5 yea rs after artificial urinary sphincter implantation. Despite this high reope ration rate, an excellent level of continence is maintained.