Tandem transcorporal artificial urinary sphincter cuff salvage technique: surgical description and results

Abstract

Purpose: Complications associated with placement of artificial urinary sphincter may make reoperation necessary. We present a surgical description and outcome data for tandem transcorporal artificial urinary sphincter salvage technique for nonmechanical artificial urinary sphincter failure.

Materials and methods: A retrospective analysis from July 2002 to December 2005 identified 198 consecutive men who underwent artificial urinary sphincter placement by a single surgeon (DSE) for postoperative stress urinary incontinence. Tandem transcorporal salvage artificial urinary sphincter surgery was performed in 18 patients with 1 (10 of 18) or both (8 of 18) cuffs placed transcorporally. Etiology of previous artificial urinary sphincter failure leading to the insertion of both cuffs in the transcorporal position included 3 infections, 2 erosions, 2 impending erosions, and 1 failed male sling. A self-administered standardized questionnaire was used to assess continence and quality of life outcomes.

Results: At a median followup of 26 months (IQR 14 to 30), pad use decreased from a median of 5.0 (IQR 3.5 to 5) to 2.0 (IQR 1 to 3) (p<0.001). Two patients experienced explantation of the device (1 erosion, 1 infection) without reimplantation and, thus, were excluded from outcome analysis. Eleven (69%) required 2 or fewer pads daily, and 5 (31%) required 3 pads daily. Eleven (69%) reported being very or extremely improved. Of the 5 patients reporting some or no improvement 4 were also on androgen deprivation therapy, suggesting that the transcorporal technique may be less durable in this group of patients.

Conclusions: Tandem transcorporal artificial urinary sphincter placement is an effective approach to salvage cases with a high risk of repeat erosion or infection after failed artificial urinary sphincter placement.