The study is based on the review outcomes and experience of artificial urinary sphincter implantation for patients with refractory urinary incontinence from different causes.
AUS placement is primarily performed in men with post-radical prostatectomy (RP) incontinence; there is scant published data for other etiologies. Interestingly, the majority priority cases for AUS implantation in our institute have been incontinence secondary to urethral injuries and neurogenic cases.
A series of urinary tract reconstruction (UTR) might be needed combining AUS placement and other additional procedures in complex cases. The type of injury, the possibility of a previous failed repair, relatively restricted surgical access, or urethral stricture, together with inherent detrusor-sphincter dysfunction, make UTR more complicated.
Thus, the quality and choice of management modalities should be tailored to the unique needs of each individual. The purpose of this study was to present our experience of AUS implantation as a part of UTR for patients with complex and refractory urinary incontinence (UI).
Between April 2002 and May 2017, a total of 32 patients (median age, 40.8 years) with urinary incontinence had undergone artificial urinary sphincter placement during urinary tract reconstruction.
Eighteen patients (56.3%) were urethral injuries associated urinary incontinence, 9 (28.1%) had neurogenic urinary incontinence and 5 (15.6%) were post-prostatectomy incontinence. Necessary surgeries were conducted before artificial urinary sphincter placement as staged procedures, including urethral strictures incision, sphincterotomy, and augmentation cystoplasty.
The mean follow-up time was 39 months. At the latest visit, 25 patients (78.1%) maintained the original artificial urinary sphincter. Four patients (12.5%) had artificial urinary sphincter revisions. Explantations were performed in three patients.
Twenty-four patients were socially continent, leading to the overall success rate as 75%. The complication rate was 28.1%; including infections (n = 4), erosions (n = 4), and mechanical failure (n = 1). The impact of urinary incontinence on the quality of life measured by the visual analogue scale dropped from 7.0 ± 1.2 to 2.2 ± 1.5 (P <0.001).
The primary sources for artificial urinary sphincter implantation in our center are unique, and the procedure is an effective treatment as a part of urinary tract reconstruction in complicated urinary incontinence cases with complex etiology.