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At least 19 recordsLinked to original sources
PubMed2000

The contemporary role of the artificial urinary sphincter.

The artificial urinary sphincter has been in use for more than 25 years as a treatment for urinary incontinence due to intrinsic sphincter deficiency. Recent clinical studies have increased our knowledge concerning its use in children and in adult patient populations. Particularly, more long-term data and data on the combination of the artificial urinary sphincter with reconstructive techniques that utilize the bowel have become available. Some interesting new ideas regarding changes in the design of the artificial urinary sphincter have been advanced.

Adult↗
PubMed1995

[Artificial urinary sphincter].

The artificial urinary sphincter is a totally implantable hydraulic prosthesis designed to restore continence without inducing dysuria. It is composed of 3 silicone elastomer elements: a periurethral or pericervical cuff, a pressure regulating reservoir balloon inserted in the retropubic space, and a pump situated in the scrotum or labia majora. The prosthesis is filled with a liquid containing a contrast agent. Pressure on the pump allows passage of liquid from the cuff towards the balloon and allows micturition. After 3 to 4 minutes, the liquid is automatically transferred from the balloon to the cuff to restore continence. The artificial sphincter is currently a very effective therapeutic solution in cases of severe urinary incontinence with 3 main indications: persistent incontinence after prostatic surgery, recurrent incontinence in women due to sphincter insufficiency, and certain forms of neurogenic incontinence. The Pitié-Salpêtrière Urology Department's experience currently consists of 200 implantations performed over the last 10 years. The overall success rate varies from 80 to 90% according to sex and the aetiology of incontinence, in patients in whom the sphincter remains in place. In fact, there is a risk of explantation due to erosion of the tissues by the cuff or infection, but this risk is less than 15%. The risk of prosthesis failure is about 20%, but after correction of the defective element, cure is achieved in almost every case. Analysis of the results in the first 120 patients with the two most frequent aetiologies and with at least three years' follow-up (range: 3 to 10 years) reveals: in a series of 75 men, treated for severe incontinence persisting more than one year after surgery for benign prostatic hyperplasia, the explantation rate was 15% and, in the patients in whom the sphincter remained in place, complete cure was obtained in 73% of cases without any incontinence, while 17% of patients suffered from minimal incontinence, not requiring protection, 7% had moderate incontinence requiring protection and 3% were considered to be failures. The revision rate for technical failure was 24%. In a series of 45 women with recurrent incontinence after surgery, due to sphincter insufficiency, the explanation rate was 13% and, in women in whom the sphincter remained in place, complete success was obtain in 78% of cases without any incontinence, while 17% suffered from minimal incontinence, usually not requiring protection, 5% require protection, with no failures and a revision rate for technical failure of 24%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2006

Outcomes following erosions of the artificial urinary sphincter.

PURPOSE: Artificial urinary sphincter urethral cuff erosion occurs in up to 5.0% of cases, presenting a complex management problem. We examine our experience with the eroded AUS, relating to preoperative risk factors, operative management and outcomes. MATERIALS AND METHODS: We reviewed the medical records of 637 patients undergoing bulbar urethral AUS implantation from 1990 to 2003 for demographic and surgical variables. RESULTS: Of the 637 records reviewed, 46 patients underwent 54 explantations of the AUS device for erosions, including 13 who had the primary implant performed at our institution and 33 being referred for management of erosion after implantation elsewhere. Our institution erosion rate was 2.2%. Mean followup after AUS reimplant following erosion was 27.8 months (range 1 to 180). Comorbidities were more prevalent in patients with erosions included hypertension (p = 0.006), coronary artery disease (p = 0.03), prior radiation therapy (p = 0.006) and prior AUS revisions (p = 0.0001). A majority of patients had persistent mild incontinence (0 to 1 pad daily in 29 or 56.8%), moderate (1 to 3 pads daily in 9 or 17.4%) and severe (more than 3 pads daily in 6 or 11.8%) incontinence after secondary AUS implantation. Patients who underwent reimplantation after AUS cuff erosions have a significantly higher rate of second erosions (in 16, 34.8%) within an average of 6.7 months (range 3 to 24), including our own 11.8% institutional rate (in 4). CONCLUSIONS: Our study suggests that patients with comorbidities including hypertension, coronary artery disease, prior radiation therapy and prior AUS revisions are more likely to have erosions of their AUS. Nevertheless, continence can still be salvaged using various strategies which optimize use of the remaining healthy urethral tissue.

Aged↗
PubMed1984

Long-term followup of the artificial urinary sphincter.

The artificial urinary sphincter with a pressure regulating balloon was implanted in 30 patients. All implantations were done before September 1982, for a minimum followup of 1 year and an average followup of 3.7 years. Of the patients 21 (70 per cent) have a functioning sphincter: 17 are continent and 4 are slightly incontinent, requiring 1 pad per day. Failure was owing to erosion in 6 patients and infection of the device in 3. Critical factors for successful implantation include preoperative evaluation, cuff location and pressure, primary deactivation and postoperative care. Our experience supports the further use of this device in appropriate cases.

Adult↗
PubMed1991

[The role of imaging in the diagnosis of complications in patients with artificial urinary sphincter].

The artificial urinary sphincters are implanted to treat some urinary incontinence. Abdominal plain films allow the checking of the function of the cuff; the diameter of the pressure regulating balloon can be appreciated by ultrasound or plain film. The main complications (bending of the tubules, leak, urethral erosion, rupture of the cuff) and their radiological diagnosis are described.

Bioprosthesis↗
PubMed1983

Treatment of the epispadias-exstrophy complex with the AS792 artificial urinary sphincter.

The AS792 artificial urinary sphincter was implanted in 11 incontinent patients with the epispadias-exstrophy complex. To date 10 patients (91 per cent) are totally continent of urine with normal renal function and intact urinary systems. The recent reports concerning success with bladder neck reconstruction in this syndrome are reviewed. Owing to the relatively poor success of this procedure in achieving total urinary continence it is recommended strongly that insertion of the artificial urinary sphincter be the initial anti-incontinence procedure for these patients. The success rate with the artificial sphincter currently is superior to any form of bladder neck reconstruction in patients with the epispadias-exstrophy complex.

Adolescent↗
PubMed1989

Compatibility of enterocystoplasty and the artificial urinary sphincter.

Placement of the artificial urinary sphincter during augmentation enterocystoplasty may lead to infection, erosion and eventual removal of the device. To assess compatibility of artificial urinary sphincter implantation and enterocystoplasty we reviewed the records of 30 patients who had undergone enterocystoplasty and artificial urinary sphincter placement simultaneously (11), enterocystoplasty before artificial urinary sphincter placement (12) and artificial urinary sphincter placement before enterocystoplasty (7). The 19 male and 11 female patients were between 4 and 42 years old (median age 13.5 years). Followup in 28 patients ranged from 6 months to 8 years (average 17 months). Incontinence resulted from myelodysplasia in 16 patients, sacral agenesis in 3, spinal cord injury in 6, posterior urethral valves in 1, bilateral ectopic ureters in 1 and epispadias-exstrophy in 3. Erosion occurred in 2 patients (7 per cent): 1 female patient who underwent simultaneous sphincter implantation and enterocystoplasty and who had undergone previously many bladder neck reconstructive procedures, including polytetrafluoroethylene (Teflon) injection, and 1 female patient in whom the augmented bladder was entered at artificial urinary sphincter implantation. Mechanical failure occurred 4 times in 3 patients and the artificial urinary sphincter was improperly placed in 1. Over-all continence rate was 87 per cent (26 of 30 patients). Simultaneous placement of the artificial urinary sphincter and enterocystoplasty did not seem to affect the outcome of sphincter implantation if good bowel preparation, intravenous antibiotics and sterility of urine were accomplished preoperatively. Entering the augmented bladder during sphincter implantation may predispose to infection and erosion.

Adolescent↗
PubMed2005

Simultaneous augmentation cystoplasty is associated with earlier rather than increased artificial urinary sphincter infection.

PURPOSE: While artificial urinary sphincter infection or erosion occurs in 20% of implantations, the risk factors are poorly understood. One of the most contentious factors reported to increase prosthesis infection is simultaneous sphincter implantation and augmentation cystoplasty. In contrast to some reports, to date our results have not shown an increased infective risk with the simultaneous procedure. We reviewed the long-term infective complications of 195 sphincters to investigate for predisposing infective factors and review the role of augmentation cystoplasty. MATERIALS AND METHODS: We performed a retrospective case note review of 144 patients with a median followup of 112 months. Augmentation cystoplasty performed in 86 patients (60%) and was simultaneous in 56. All patients were reviewed within the last year or followed until death or sphincter failure. Patient, surgical and treatment factors were statistically analyzed for associations with prosthesis infection. RESULTS: A total of 108 sphincters failed from infection (25%), tissue atrophy (5%) or mechanical reasons (25%). The overall infective failure rate was similar in patients who underwent simultaneous augmentation (30%) compared with the other patients (23%), although there was a statistically significant difference within the first 3 postoperative years (log rank p = 0.009). While no other variables were significantly associated with sphincter infection, intermittent self-catheterization did not increase sphincter infection and females appeared to have more prosthesis infections. CONCLUSIONS: Our results suggest that, while simultaneous augmentation cystoplasty and artificial urinary sphincter implantation lead to an initial increase in prosthesis infection, this difference disappears after 3 years.

Adult↗
PubMed1986

Management of neurogenic urinary incontinence with AMS artificial urinary sphincter.

The AMS artificial urinary sphincter was implanted in 33 patients with neurogenic urinary incontinence during a 10-year period. All sphincter types were employed, from the earliest AS 721 model to the latest AS 800. The mechanically unstable AS 721 and 761 types have all been removed and, when possible, replaced by later models. In 27 of the 33 patients the device is still in situ, and in 6 (18%) it was removed, mainly because of urethral erosion. Increasingly favourable sphincter survival rats have been obtained. The overall survival rate for model AS 742 was 55% (7 years) for first implant, while the 4-year survival rate for AS 791/792 was 90%. Successful control of voiding function, defined as complete continence or slight but not socially inconvenient incontinence, was obtained in 25 patients (76% of the series).

Adolescent↗
PubMed1988

Renal transplantation in a patient with an artificial urinary sphincter device.

Use of the artificial urinary sphincter device has become widespread. We describe the successful transplantation of a renal allograft into a recipient with an artificial urinary sphincter. Pretransplant placement of a sphincter, intraoperative avoidance of the prosthetic device and proper urinary drainage perioperatively make the artificial urinary sphincter device a feasible means to provide continence in a renal transplant recipient.

Adult↗
PubMed2004

An unusual use of AMS 800 artificial urinary sphincter cuff in the treatment of sphincteric neurogenic incontinence: case report.

STUDY DESIGN: Case report of an unusual use of AMS 800 (American Medical Systems, Inc., Minnetonka, Minnesota) artificial urinary sphincter cuff in a female patient affected by neurogenic urinary incontinence. OBJECTIVE: To describe this rare surgical solution. SETTING: Department of Urology in Italy. METHODS: A 43-year-old woman affected by flaccid paraplegia, acontractile bladder and incompetent bladder neck, underwent an implantation of an artificial urinary sphincter AMS 800. After 7 years, a mechanical failure of the device occurred and pubovaginal sling (PVS) utilizing the cuff of the sphincter was employed due to the poor quality of rectus fascia and the development of previous allergy for some heterologous materials. RESULTS: At 17 months follow-up, the patient is content and able to empty the bladder by clean intermittent self-catheterization (CIC). CONCLUSION: The risk of developing an allergy reaction due to the employment of heterologous materials and the impossibility to use the rectus fascia obliged us to adopt the pre-existent cuff of the artificial urinary sphincter AMS 800.

Adult↗
PubMed1999

[Long-term follow-up of children with neurogenic bladder and artificial urinary sphincter].

MATERIALS AND METHODS: Since 1986 an artificial urinary sphincter was implanted in 16 children (13 males and 3 females) 4 to 12 years old (median age 9) in order to solve their urinary incontinence. Mean age at implantation was 9 years. In 10 children (63%) only the implant procedure of artificial sphincter was performed without any other procedure associated (Group A), while in 6 children an augmentation cystoplasty simultaneously was performed (Group B). The results were analysed in both groups separately: 1. Group A: 10 patients. Two are functioning excellently after 10 and 11 years of follow up. Eight developed some type of troublesome: Five developed a deterioration of urinary tract and all of five were treated by augmentation cystoplasty; one of them is in a good condition after 11 years, another presented a fail of the device after 10 years, it has been changed, and in the others three the apparatus was removed by diverse causes. Two developed a mechanical fail of device: one was removed due familiar decision and the other has received another device. One urinary fistula developed 6 months later. The device was removed. 2. Group B: 6 patients (artificial sphincter and augmentation cystoplasty simultaneously). Five are functioning without trouble some. One persistent urinary fistula. The device was removed. Actually, of 16 cases (both groups) 8 cases (50%) are good functioning, 6 devices have been removed and 2 are waiting a new implant. CONCLUSIONS: The artificial urinary sphincter is a good solution for children with urinary incontinence in selected cases, but is mandatory a correct follow up because longterm complications can be developed. Results seem better when an augmentation cystoplasty is associated.

Child↗
PubMedDate not supplied

Artificial urinary sphincters.

The use of artificial sphincters for the treatment of urinary incontinence has evolved steadily over the last few decades. Currently available designs are suitable for implantation in male and female patients of all age-groups. This article describes the clinical implications of artificial urinary sphincters in the treatment of incontinent patients.

Female↗
PubMed2005

Management of male incontinence following artificial urinary sphincter failure.

PURPOSE OF REVIEW: The artificial urinary sphincter has been used successfully for the treatment of stress urinary incontinence in both male and female patients. Its most common use, however, is in men suffering from postprostatectomy incontinence. RECENT FINDINGS: The success rates, long-term durability, and patient satisfaction for the artificial urinary sphincter are high. The incidence of complications and adverse events remains low although they are sometimes unavoidable. SUMMARY: We believe that continence can be salvaged in the majority of men in whom the device fails or requires explantation and we present the logical analysis for device revision and relocation in this review.

Adult↗
PubMed1984

Selection of patients for implantation of the Brantley Scott artificial urinary sphincter.

The Brantley Scott artificial urinary sphincter (AUS) is a safe, effective and relatively trouble-free device for the control of sphincter weakness incontinence. Suitable patients should have no other urodynamic dysfunction or have had such a dysfunction corrected or controlled. Patients with post-prostatectomy incontinence pose no problems in selection, although as a group they are the most prone to develop complications. Pure stress incontinence does not warrant implantation of an AUS except in very rare instances. In neuropathic dysfunction the AUS is one of several treatment options for the correction of incontinence and is most effectively used as such. In all patients, thorough pre-operative videourodynamic evaluation is essential to get the best results and therefore to justify the infective and mechanical risks and the expense of the device.

Female↗
PubMed2000

The long-term outcome of artificial urinary sphincters.

PURPOSE: We reviewed the outcome of artificial urinary sphincters inserted more than 10 years ago. MATERIALS AND METHODS: We analyzed the records of 100 patients and mailed a questionnaire to those without recent followup. RESULTS: Overall 84 patients were continent, including 36 with the original artificial urinary sphincter in place who were dry at a median followup of 11 years and 27 in whom the device was successfully replaced due to mechanical failure who were previously continent for a median of 7 years. In 21 patients it was removed due to infection or erosion and reimplantation was successful 3 to 6 months later or they remained dry without another artificial urinary sphincter. Of the male patients with a bulbar and bladder neck sphincter 92% and 84%, respectively, were continent at 10 years as well as 73% of the females. Device survival was 66% at 10 years. Overall 37% of the prostheses were removed due to infection or erosion in the 10-year period with the highest risk in females (56%) and lowest in males with a bulbar sphincter (23%). CONCLUSIONS: The artificial urinary sphincter is effective long-term treatment for incontinence in male patients. In female patients the risk of erosion is high, although overall long-term continence is satisfactory.

Adolescent↗
PubMed2000

[Artificial urinary sphincter].

OBJECTIVE: To review the literature on artificial urinary sphincters, to describe their function, technique of implantation, indications, results and complications, and to analyze the possible utility of the prosthesis in the treatment of stress incontinence. METHODS: Medline (Index Medicus Online) and Embase (Excerpta Medica Online) were accessed to review the literature on artificial urinary sphincters published from 1974 (when the first artificial urinary sphincter was described by Foley) to October 1999. Of 322 articles identified, only those that described the patient selection criteria, type of prosthesis utilized, results and complications, and mean follow-up were considered. Articles describing historical aspects and new prototypes were also reviewed. Papers by the authors of the present article were excluded to avoid the bias of author preference. The bias of the language barrier, which occurs when articles published in Spanish, English and French are reviewed, was minimum. RESULTS: The AMS-800 is the only model available today. The results achieved are excellent if the indication is correct and perioperative management is careful and exact. The ideal candidate is one with genuine stress urinary incontinence and normal bladder function, although hyper or hyporeflexia is not an absolute contraindication if corrected before, during or after insertion of the prosthesis. The surgical technique is relatively simple and the only difficulty consists in the choice of the appropriate cuff and reservoir. The complications include urethral atrophy, erosion, infection and bladder instability, and are less frequent in women with stress urinary incontinence type III and in men incontinent after prostate surgery, and more frequent in patients with incontinence following pelvic trauma, incontinence due to congenital malformation and those with a neurogenic bladder. The mechanical failures of the prosthesis have diminished with its improved design. New hydraulic and non-hydraulic prototypes have been designed to reduce the complications, but the results are as yet unavailable. CONCLUSIONS: Today, patients with stress urinary incontinence have more possibilities to recover continence. If incontinence persists after all the available medical and surgical options have been attempted, one possibility still remains: the artificial urinary sphincter.

Female↗