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Review
. 2024 Aug 31;13(8):1641-1649.
doi: 10.21037/tau-22-830. Epub 2024 Aug 16.

Surgical strategies in artificial urinary sphincter revision surgery: troubleshooting the complications

Marcio Augusto Averbeck  1   2 , Silvio Henrique Maia de Almeida  3
Affiliations
Review

Surgical strategies in artificial urinary sphincter revision surgery: troubleshooting the complications

Marcio Augusto Averbeck et al. Transl Androl Urol. .

Abstract

Post-prostatectomy urinary incontinence (PPUI) is an important issue in the urological practice and imposes a negative effect on quality of life (QoL). Despite recent technological advances, PPUI remains a common complication and the artificial urinary sphincter (AUS) is regarded as the most effective long-term surgical treatment for moderate-to-severe stress urinary incontinence. Success rates for AUS as defined by a continence status of zero to one pad per day range from 59% to 90%. One potential downside of the AUS is the need for periodic revisions in a number of patients. Revision and explantation rates due to mechanical failure, urethral atrophy, infection and erosion vary considerably among studies with reports of 8-45% and 7-17%, respectively. These complications can be classified into different categories, including recurrent or refractory incontinence, erosion and/or infection, and other complications. This review article aims to describe the main AUS-related complications and their management strategies. Diagnostic work-up strategies are explored to facilitate timely identification and management of these complications. Additionally, emerging technologies and future directions in AUS development are discussed, highlighting potential advancements to mitigate complications and enhance device performance. This review consolidates current knowledge and provides insights for clinicians to manage the complexities associated with AUS therapy effectively.

Keywords: Post-prostatectomy; artificial urinary sphincter (AUS); urinary incontinence.

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Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-22-830/coif). The series “50 Years Anniversary of the Modern Artificial Urinary Sphincter” was commissioned by the editorial office without any funding or sponsorship. M.A.A. is a member of the Coloplast Continence Advisory Board, and received fees from Medtronic (proctor for sacral neuromodulation) and from Boston Scientific (proctor for AMS800 implants). S.H.M.d.A is a member of the Coloplast Continence Advisory Board. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Incipient infection: perineal fistula (black arrow) and scrotal hyperemia.
Figure 2
Figure 2
Perineal erosion.
Figure 3
Figure 3
Algorithm for managing incontinence after artificial urinary sphincter placement. AUS, artificial urinary sphincter; PVR, post-void residual; OAB, overactive bladder.
Figure 4
Figure 4
Urethroscopy demonstrating cuff erosion.
Figure 5
Figure 5
Cuff removal after urethral erosion.
Figure 6
Figure 6
Primary urethral repair following cuff removal. The white arrow shows the final appearance of the urethroplasty and closed capsule after cuff removal.
See this image and copyright information in PMC

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