Tandem cuff artificial urinary sphincter as a salvage procedure following failed primary sphincter placement for the treatment of post-prostatectomy incontinence

Purpose: Management of post-artificial urinary sphincter (AUS) urethral atrophy can be difficult for the treating physician, yielding unsatisfactory results for the patient. As with many incontinence procedures, initial results are generally encouraging. We determined the durability and success of tandem cuff placement for urethral atrophy following AUS placement. Materials and Methods: We reviewed the records of 18 patients with a mean age 74 years who underwent tandem AUS placement from 1994 to 2001. Mean followup was 3.3 years. All patients originally underwent AUS placement for post-prostatectomy stress urinary incontinence and they had subsequent incontinence secondary to urethral atrophy. Adjuvant radiation in 3 cases, hormone therapy in 3, cuff size and pressure, and multiple continence procedures prior to tandem cuff placement in 5 were evaluated as risk factors for cuff erosion. Long-term followup was obtained through office examination and telephone interview using a standardized questionnaire regarding voiding habits and satisfaction. Results: Following tandem cuff placement mean +/-SD pad use daily decreased from 4.3 +/- 0.35 (median 3) to 1.6 +/- 0.42 (median 1) (p <0.0001). Overall 10 of the 18 patients (56%) needed 1 pad or less daily, 16 (88%) would have the tandem cuff placed again and 17 (94%) would recommend the procedure. Median subjective improvement and satisfaction was 4.7 and 4.0, respectively, on a scale of 0 to 5. Reoperation was required for cuff leakage in 1 case and cuff erosion in 2. One patient with erosion had 3 prior AUS revisions, including placement of a 71 to 80 cc balloon reservoir. Conclusions: Placement of tandem urethral cuff as a salvage procedure for recurrent stress urinary incontinence provides marked sustained improvement in leakage and overall high patient satisfaction in the difficult setting of urethral atrophy.