1608 DECOMPENSATION OF AMS 800 RESERVOIR ELASTICITY AS A MECHANISM FOR GRADUAL ARTIFICIAL URETHRAL SPHINCTER FAILURE: A CASE SERIES DEMONSTRATING NOVEL EVALUATION AND TREATMENT WITH RESERVOIR REPLACEMENT ALONE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20101608 DECOMPENSATION OF AMS 800 RESERVOIR ELASTICITY AS A MECHANISM FOR GRADUAL ARTIFICIAL URETHRAL SPHINCTER FAILURE: A CASE SERIES DEMONSTRATING NOVEL EVALUATION AND TREATMENT WITH RESERVOIR REPLACEMENT ALONE Phillip Pierorazio and Jacek Mostwin Phillip PierorazioPhillip Pierorazio More articles by this author and Jacek MostwinJacek Mostwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1386AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Progressive deterioration of urinary continence after artificial urethral sphincter implantation occurs in 3 to 9% of patients. The most common etiology is believed to be urethral atrophy with recommended treatment including replacement or doubling of the urethral cuff with or without replacement of other components. We have identified a previously unrecognized mechanism: reduced reservoir elasticity. METHODS Nine patients operated on by a single surgeon were noted to have mechanical failure of the artificial sphincter reservoir. All patients described a gradual reduction of continence with increasing need for absorbent protection. Pre-operative cystoscopy excluded erosion; plain x-rays showed contrast in the system. At re-exploration, mechanical failure was investigated using standard arterial catheter pressure sensors provided with anesthesia machines. If pressure readings below manufacturer's specifications were noted, the reservoir alone was replaced; the perineum and cuff were left intact. Reservoirs were returned to the manufacturer for evaluation. Patient outcomes were self-reported to the surgeon. RESULTS Median age at initial artificial sphincter implantation was 61 yrs (52 - 75); average time to revision was eight yrs (3 to 13). At initial implantation, all patients received 4.5 cm cuffs; all but one had 61-70 cmH2O reservoirs, and one had a 71-80 cmH2O reservoir. The mean reservoir pressure in situ at re-exploration was 36 mmHg (27 – 41mmHg). Converted to cmH2O, the pressures were 50.4 cmH2O (37.8-57.4). The mean volume was 27 cm3 (25 - 30) which is higher than the standard volume of 20 cm3. In each case, the reservoir pressure was less than the nominal pressure range. Evaluation by the manufacturer revealed appearance and behavior consistent with the duration of implant. In all patients the artificial sphincter reservoir was replaced through the initial inguinal incision. All patients had complete restoration of urinary continence; one patient eventually required cuff revision due to subsequent erosion. CONCLUSIONS In the subset of patients with gradual and progressive incontinence following artificial sphincter implantation, reduced reservoir pressure can be investigated and confirmed intra-operatively. If abnormal, the reservoir can be replaced through a very limited operation, restoring urinary control without replacement or revision of the urethral cuff. Baltimore, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e621 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Pierorazio More articles by this author Jacek Mostwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...