The artificial urinary sphincter in 86 patients with intrinsic sphincter deficiency: satisfactory actuarial adequate function rates

Abstract

Objective: To evaluate the long-term results of the AMS-800 artificial urinary sphincter (AUS) in patients with incontinence due to intrinsic sphincter deficiency, taking into account the continence status and the durability of the device.

Patients and methods: Between 1984 and 1997, an AUS was implanted in 86 patients. Kaplan-Meier survival analysis was used to determine the 'primary adequate function' rate (P-AF) and the 'additional procedure assisted adequate function' rate (APA-AF). These rates define adequate function as satisfactory continence (use of maximally 1 pad per 24 h) in combination with good AUS function. In the case of P-AF, no revisions have been required. In the case of APA-AF, one or more revisions of parts of the AUS are acceptable but a complete exchange or explantation of the AUS marks its endpoint.

Results: At last follow-up, satisfactory continence was found in 76% of the patients. Continence was markedly improved in another 7%. The 5-year P-AF and APA-AF rates were 46 and 67%, respectively. The 5-year P-AF rates for the periods before and after the introduction of the narrow backed cuff were 33 and 61%, respectively (p = 0.03).

Conclusions: The AUS can give excellent results as far as urinary continence is concerned, but only at the expense of a considerable reoperation rate. The 5-year actuarial primary adequate function rate has almost doubled since the introduction of the narrow backed cuff design.