Artificial Urinary Sphincters for Treatment of Urinary Incontinence in Elderly Males

Introduction: We sought to examine the role of advanced age (defined as >70 years), impaired cognitive function, and decreased manual dexterity in the rates of re-operation (revision or replacement) of artificial urinary sphincters (AUS). Methods: From 1988 to 2012, 213 men underwent virgin AUS placements. Failure was defined as a revision performed for stress incontinence and replacement/exploration performed for urethral erosion/infection or mechanical failure. Kaplan Meier curves were constructed to compare failure rates with age and Cox proportional hazard models were used to test associations. Results: Advanced age was not associated with overall failure (p = 0.48), erosion/infection failure (p = 0.65), recurrent/persistent incontinence failure (p = 0.08), or mechanical failure (p = 0.36). Controlling for age, patients with cognitive dysfunction or decreased manual dexterity showed a higher rate of overall failure (p = 0.01). Conclusions: AUS placement is an excellent option to treat stress urinary incontinence in elderly men with intact cognition and good manual dexterity. AUS placement should be performed with caution in patients with impaired cognitive function or decreased manual dexterity, and additional effort should be made to identify these conditions both before and after surgery. (C) 2016 S. Karger AG, Basel