Comparison of outcomes for adjustable bulbourethral male sling and artificial urinary sphincter after previous artificial urinary sphincter erosion

Abstract

Objectives: To compare the outcomes of the adjustable bulbourethral male sling and artificial urinary sphincter (AUS) in patients with recurrent postprostatectomy incontinence after previous AUS erosion.

Methods: Sixteen patients with recurrent postprostatectomy incontinence who had undergone either adjustable bulbourethral male sling placement (group 1, n = 8) or AUS implantation (group 2, n = 8) were included in the study. The preoperative evaluations included history, physical examination, International Consultation on Incontinence Questionnaire-short form, pad test, cystoscopy, and urodynamic studies. The follow-up examinations were performed at 1, 3, 6, and 12 months postoperatively and annually thereafter.

Results: The mean follow-up was 10 months (range 7-19) and 22 months (range 6-38) for groups 1 and 2, respectively (P = .009). Of the 16 patients, 6 were cured, 1 with the sling and 5 with the AUS (cure was defined as no pads daily); 3 were improved, 1 with the sling and 2 with the AUS (improvement was defined as no more than 2 pads daily), and 7 had treatment failure, 6 with the sling and 1 with the AUS. No intraoperative complication was seen in either group. Readjustment of sling tension was done in 4 patients who had persistent incontinence. No reoperation, excluding the readjustments, was required in group 1; however, 3 patients had transient perineal pain. The AUS was removed for recent erosion at 6 and 12 months postoperatively in 1 cured patient and 1 patient with treatment failure, respectively. Ultimately, 50% of the patients (25% with the sling and 75% with the AUS) were cured or improved.

Conclusions: The results of our study have shown that AUS implantation results in better outcomes than placement of the adjustable bulbourethral male sling as secondary therapy.