Efficacy of artificial urinary sphincter implantation after failed bone-anchored male sling for postbrostatectomy incontinence

Abstract

OBJECTIVES To evaluate the feasibility and efficacy of artificial urinary sphincter placement after failed bone-anchored male sling for postprostatectomy stress urinary incontinence.

METHODS Eleven patients with postprostatectomy stress urinary incontinence who failed bone-anchored male sling underwent artificial urinary sphincter placement. All patients were evaluated before and after artificial urinary sphincter placement with a history and physical examination, pad score, and the incontinence section of the University of California, Los Angeles (UCLA)/RAND prostate cancer index (total score possible = 26). Urodynamic evaluation was performed before sphincter placement.

RESULTS The average age in our study population was 70 years (range, 51 to 80 years). The mean follow-up after artificial urinary sphincter placement was 14.2 months (range, 3 to 20 months). Incontinence was defined as mild (I to 2 pads), moderate (3 to 5 pads), or severe (more then 5 pads). After sling placement, cure was defined as no pad use, failure as same pad usage, and improvement as fewer pads used. The severity of incontinence before artificial urinary sphincter placement was mild, moderate, and severe in 3, 1, and 7 patients, respectively. After artificial urinary sphincter placement the severity of incontinence was cured, mild, and moderate in 8, 2, and 0, respectively. One patient required artificial urinary sphincter removal because of infection. Mean UCLA/RAND scores increased from 10.8 to 19.7. Patient satisfaction after artificial urinary sphincter placement was 74.5%. No intraoperative complications or urethral injuries occurred.

CONCLUSIONS Artificial urinary sphincter placement after failed bone-anchored male sling is technically feasible and does not affect the short-term efficacy of the artificial sphincter.