eMedicine Specialties > Urology > Incontinence

Artificial Urinary Sphincter: Follow-up

Author: Kamran P Sajadi, MD, Staff Physician, Division of Urology, Medical College of Georgia Health System
Coauthor(s): Martha K Terris, MD, FACS, Professor, Department of Surgery, Medical College of Georgia
Contributor Information and Disclosures

Updated: Dec 5, 2008

Outcome and Prognosis

American Medical Systems (AMS, the manufacturer of the artificial urinary sphincter) reports the placement of over 94,000 artificial urinary sphincters in men and women. Social continence (1 pad or fewer a day) at 3-year follow-up is achieved in 75-95% of patients. The largest study of artificial urinary sphincter in the literature reports that 90% of patients have a functional artificial urinary sphincter in place at a mean follow-up of 5 years, with a 28% revision rate.14 The efficacy in women compares with that in men, although there are fewer studies of the efficacy of artificial urinary sphincter in women, largely because women are more often treated with bladder neck suspension and suburethral sling procedures.15

The largest single-institution series in children demonstrates a total continence rate of 86% and a revision rate of 25%.16 Multiple series have supported the safety of concomitant augmentation cystoplasty in patients with intrinsic sphincteric dysfunction and small-capacity or poorly compliant bladders. Another review showed better clinical outcomes in children when the artificial urinary sphincter was implanted before puberty and when preoperative or concomitant augmentation cystoplasty was performed.17 However, most of these patients still require long-term clean intermittent catheterization.

In patients with neuropathic bladder dysfunction, close urodynamic follow-up is advised after artificial urinary sphincter placement, as urodynamic parameters can change profoundly over time.

The patient satisfaction rate is reported to be 85-95% and depends more on the degree of improvement than on the achievement of total continence. Success is likely in large part influenced by proper patient selection and careful patient education regarding expectations and the possible, even eventual, need for operative revisions.

Future and Controversies

Placement of the AMS 800 is an excellent surgical treatment for men, women, and children with type III stress urinary incontinence. Extremely reliable and durable, the AMS 800 has greatly improved the quality of life in patients with stress urinary incontinence.

Despite recent advances in mechanical design, certain limitations exist with this device. When mechanical malfunctions and surgical problems arise, repeat surgery is often diagnostic and therapeutic. With continued advances in biomechanical engineering, an even better artificial urinary sphincter—one that approaches the function of a biological urinary sphincter—should be forthcoming.

The presence of recurrent bladder neck contracture in combination with postprostatectomy stress incontinence is a difficult problem to treat. Recurrent bladder neck contractures are often treated with incision (direct-vision internal urethrotomy [DVIU]) or transurethral incision of the bladder neck contracture (TUIBNC) followed by implantation of an artificial urinary sphincter. Alternatively, intermittent catheterization is advocated to allow the contracture to "soften up" and stabilize over time. After the contracture has stabilized, an artificial urinary sphincter may be placed. The exact timing of sphincter placement is tailored to each individual, but at least 3 months of patency since the last procedure is generally recommended. Some encouraging results have been reported of concomitant or staged artificial urinary sphincter with stenting (UroLume stent [AMS] of the bladder neck contracture in patients with recurrent, difficult-to-treat stricture).

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jong M. Choe, MD, FACS, to the development and writing of this article.



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References
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Further Reading

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Keywords

artificial urinary sphincter, AUS, artificial sphincter, AMS 800, artificial genitourinary sphincter, prosthetic sphincter, incontinence, stress incontinence, urge incontinence, post-prostatectomy incontinence, postprostatectomy incontinence, stress urinary incontinence, urinary sphincter, type III stress urinary incontinence, intrinsic sphincter deficiency, ISD, incompetent urethra, intrinsic sphincteric dysfunction, intrinsic sphincter dysfunction

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Contributor Information and Disclosures

Author

Kamran P Sajadi, MD, Staff Physician, Division of Urology, Medical College of Georgia Health System
Kamran P Sajadi, MD is a member of the following medical societies: American Urological Association, Endourological Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Martha K Terris, MD, FACS, Professor, Department of Surgery, Medical College of Georgia
Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Urological Association, New York Academy of Sciences, and Society of University Urologists
Disclosure: Nothing to disclose.

Medical Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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