Tulane experience with management of urinary incontinence after placement of an artificial urinary sphincter

• Published in: World journal of urology 1994-12, Vol.12 (6), p.333-336
• Main Authors: GHONIEM, G. M, LAPEYROLERIE, J, SOOD, O. P, THOMAS, R
• Format: Article
• Language: English
• Subjects: Algorithms; Biological and medical sciences; Equipment Failure; Female; Fluoroscopy; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Urinary Bladder Neck Obstruction - complications; Urinary Bladder Neck Obstruction - diagnostic imaging; Urinary Bladder, Neurogenic - complications; Urinary Bladder, Neurogenic - diagnostic imaging; Urinary Incontinence - etiology; Urinary Incontinence - physiopathology; Urinary Incontinence - therapy; Urinary Sphincter, Artificial - adverse effects; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics - physiology; Videotape Recording
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/BF00184115

Persistent urinary incontinence following placement of an artificial urinary sphincter (AUS) presents a challenging diagnostic problem. This report reviews 30 cases (27 males and 3 females) involving urinary incontinence following AUS placement. The mean age of the patients was 64.4 years (range, 10-79 years). Physical examination demonstrated evidence or suspicion of infection or erosion in 7 patients, and subsequent cystoscopic examination revealed erosion caused by the cuff in 6 of these 7 cases. The remaining 23 patients were evaluated by videofluorourodynamics (VFUD) to ascertain the cause of incontinence. VFUD demonstrated detrusor instability in 9 patients (39%), low detrusor compliance in 3 patients (13%), and poor detrusor contractility in 1 patient (4.4%). Bladder-outlet obstruction was diagnosed in 2 patients (8.8%)-1 with bladder-neck contracture and 1 with ureteral stricture. Altogether, 2 (8.8%) cases of tissue atrophy were diagnosed with low urethral closing pressure at the cuff. In all, 1 patient (4.4%) was diagnosed as having a vesicovaginal fistula, 1 (4.4%) had a tubing kink, and 4 (17%) had leaking devices diagnosed during VFUD by cycling of the device. Of the 23 patients, 21 (91%) demonstrably improve or became fully continent after appropriate treatment had been initiated. A review of this study suggests that the majority of incontinent patients after AUS implantation can be managed successfully, provided that a systematic diagnostic approach is followed and appropriate treatment is initiated.