1016 IMPACT OF THE 3.5 CM ARTIFICIAL URINARY SPHINCTER CUFF IN PRIMARY AND REVISION SURGERY FOR MALE STRESS URINARY INCONTINENCE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence: Evaluation & Therapy1 Apr 20111016 IMPACT OF THE 3.5 CM ARTIFICIAL URINARY SPHINCTER CUFF IN PRIMARY AND REVISION SURGERY FOR MALE STRESS URINARY INCONTINENCE Steven Hudak, Celeste Valadez, Ryan Terlecki, and Allen Morey Steven HudakSteven Hudak Dallas, TX More articles by this author , Celeste ValadezCeleste Valadez Dallas, TX More articles by this author , Ryan TerleckiRyan Terlecki Dallas, TX More articles by this author , and Allen MoreyAllen Morey Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1050AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 3.5 cm artificial urinary sphincter (AUS) cuff was introduced to the US market in January 2010 for the treatment of men with stress urinary incontinence in the presence of periurethral atrophy. The objective of this study is to identify what proportion of AUS patients are appropriate candidates for the 3.5 cm cuff. METHODS A retrospective review was performed of all men who underwent AUS placement by a single surgeon since September 2009 (date of initial 3.5 cm cuff availability). In all cases, a perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum, and a simple technical modification using a redesigned measuring tape was used to obtain precise measurement of the spongiosal circumference. In reoperative cases, downsizing to the 3.5 cm cuff was done in lieu of tandem cuff placement. Transcorporal (TC) cuff placement was reserved primarily for men with a history of prior AUS erosion or complex urethroplasty. RESULTS During the 14 month study period, the majority of our patients (45/67, 67%) received the 3.5 cm AUS cuff, with no difference seen between primary and revision AUS cases (73% vs. 58%, p=0.19). In primary cases, the 3.5 cm cuff was used more frequently in those without previous urethral surgery (84% vs. 56%, p=0.056). Slightly higher rates of erectile dysfunction (89% vs. 77%, p=0.28) and prior radiation (47% vs. 27%, p=0.12) were noted in men with 3.5 cm cuffs vs. ≥4.0 cm cuffs. During the study period, only 3 of 45 (7%) men with 3.5 cm AUS cuffs have required cuff removal due to erosion. CONCLUSIONS In our center, the 3.5 cm cuff has become the predominant size used for both primary and revision AUS placement, while emphasizing the importance of proximal cuff location and accurate spongiosal measurement. Liberal use of the 3.5 cm cuff has allowed us to limit TC placement and to abandon tandem cuff placement completely, improving the simplicity of AUS placement without apparent additional morbidity. Utilization of the 3.5 cm AUS Cuff Total 3.5 cm cuff ≥4.0 cm cuff TC Primary AUS 41 30 (73%) 7 (17%) 4 (10%) -prior urethral surgery 16 9 (56%) 3 (19%) 4 (25%) -no prior urethral surgery 25 21 (84%) 4 (16%) 0 Revision AUS 26 15 (58%) 7 (27%) 4 (15%) Total 67 45 (67%) 14 (21%) 8 (12%) © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e409 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Hudak Dallas, TX More articles by this author Celeste Valadez Dallas, TX More articles by this author Ryan Terlecki Dallas, TX More articles by this author Allen Morey Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...