13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine

Purpose: We reviewed 13 years of experience with artificial urinary sphincter implantation (narrow backed cuff) at a single institution. Materials and Methods: Between 1992 and 2005, 270 patients underwent artificial urinary sphincter implantation, as performed by a single surgeon at Baylor College of Medicine, and followup data were available on 218 of them. Mean followup was 36.5 months (maximum 151.4). Of the 218 patients 60 underwent prostatectomy and pelvic radiation, 116 underwent prostatectomy without radiotherapy, 11 had neurogenic bladder and 31 underwent secondary artificial urinary sphincter implantation. Results: The complication rate did not differ among the 4 treatment groups. Complication rates were infection in 5.5% of cases, erosion in 6.0%, urethral atrophy in 9.6%, mechanical failure in 6.0% and surgical removal or revision in 27.1%. Median time to complications was 3.7 months for infection, 19.8 months for erosion, 29.6 months for atrophy, 68.1 months for failure and 14.4 months for surgery. At 5 years 75% of patients were free from revision or removal. A history of failed injectable or male sling, or of Valsalva voiding did not adversely impact the outcome. The rate of bladder neck contracture was high in artificial urinary sphincter candidates, especially in irradiated patients (36% and 57%, respectively). Patients with prior pelvic radiation continued to be at higher risk for contracture recurrence after artificial urinary sphincter implantation (12%). Two-stage UroLume (R) stent and artificial urinary sphincter placement offered long-term contracture and continence control in 8 of 11 patients with recurrent anastomotic contractures. Conclusions: An artificial urinary sphincter is durable treatment for sphincter deficiency even in patients with a history of complications, neurogenic bladder, pelvic radiation, bladder neck contracture, Valsalva voiding, or failed injectables or slings.