Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: Long-term subjective results

Purpose: Incontinence affects between 3% and 60% of patients after radical prostatectomy. Insertion of an artificial urinary sphincter is a mainstay t herapeutic option available to these patients. We assessed patient satisfac tion, outcome and complications long after artificial urinary sphincter imp lantation. Materials and Methods: From a data bank of 131 patients who underwent artif icial urinary sphincter prosthesis insertion we identified 71 with a mean a ge of 72 years who had also undergone radical prostatectomy and were availa ble for evaluation. This group included 29 patients (40.8%) who received an earlier version of the AMS-800 (American Medical Systems, Minnetonka, Minn esota) and 42 (59.2%) who received the newer narrow back cuff device. Infor mation on surgical procedures and followup were obtained from a computerize d database. Patients were also contacted by an impartial reviewer who admin istered a standard telephone questionnaire on the degree of continence, com plications, other means used to help with urinary continence, proficiency i n device operation and satisfaction. Results: At a mean followup of 7.7 years (range 0.5 to 16) 19 patients (27% ) used 0, 23 (32%) used 1, 11 (15%) used 1 to 3 and 18 (25%) used more than 3 daily, while 1 used an external catheter. Surgical revision in 21 cases (29%) was required due to mechanical failure in 18 (25%), device erosion in 3 (4%) and infection in 1 (1.4%). The need for revision correlated signifi cantly with the design of the sphincter (p = 0.005). Only 7 of the 42 patie nts in whom a narrow cuff AMS-800 was implanted needed revision versus 18 o f the 23 with a previous design. Mean time to revision was 2.5 years (range 0.5 to 8). The device was removed in 2 cases (2.8%). Of the patients 41 (5 8%) are very satisfied, 14 (19%) are satisfied and 16 (23%) are unsatisfied with the device. The degree of satisfaction correlated with the number of pads used (p = 0.0005) and sphincter design (0.028) but not with the number of surgical revisions (p = 0.521) or patient age. Conclusions: The artificial urinary sphincter is a viable treatment option for post-radical prostatectomy incontinence with a high rate of continence and satisfaction for a long period after the procedure. Patients should be informed that complications necessitating device revision and explantation may appear late in followup. A standard definition of treatment success and studies of homogenous groups of patients with an artificial urinary sphinc ter would enable better understanding and patient education in the future.