Long-term follow-up of single versus double cuff artificial urinary sphincter insertion for the treatment of severe postprostatectomy stress urinary incontinence

Abstract

Objectives: To assess the long-term effectiveness and complications associated with single and double cuff artificial urinary sphincter (AUS) implantation for the treatment of severe postprostatectomy stress urinary incontinence (SUI).

Methods: We updated the outcomes of 56 men with postprostatectomy SUI who underwent single (28 patients) or double (28 patients) cuff AUS placement. Originally patients in each cohort were matched according to preoperative pad usage, risk factors for complications, and age. Continence, quality of life, and complications were assessed according to the Incontinence Impact Questionnaire Short Form (IIQ-7), postoperative pad usage, chart review, and patient/family interview.

Results: Updated data were available for 47 men (25 single cuff and 22 double cuff patients). Mean pre-AUS implant age was 67 years for each group. Average follow-up was 74.1 months and 58.0 months for single and double cuff patients, respectively. No statistically significant difference in continence improvement was noted between the two groups according to daily pad usage and overall dry rate. IIQ-7 scores improved from 14.8 to 4.1 after single cuff implants and from 16.3 to 6.4 after double cuff placement (P = 0.34). Men receiving a single cuff AUS reported seven complications requiring further operative intervention. Double cuff patients underwent 12 additional surgeries secondary to complications.

Conclusions: Despite our earlier findings, no significant difference in dry rate, overall continence, or quality of life was seen with long-term follow-up of single versus double cuff AUS patients. Furthermore, men receiving double cuff implants may be at higher risk of complications requiring additional surgery.