A SUCCESSFUL CASE OF PARTIAL REPLACEMENT FOR MECHANICAL FAILURE OF ARTIFICIAL URINARY SPHINCTER

Abstract

Of the patients who have had artificial urinary sphincter (AUS) implantation, 30%-50% require reoperation because of recurrent stress urinary incontinence (SUI) or infection. The most common cause of recurrent postoperative SUI is the mechanical failure of the AUS. This case report describes AUS replacement without urethral manipulation after the mechanical failure of the AUS. A 63-year-old man underwent AUS implantation to treat severe SUI that developed after robot-assisted laparoscopic total prostatectomy. Intraoperatively during AUS implantation, the cuff was inflated under direct vision and the AUS was confirmed to work properly; however, SUI did not improve when the AUS was activated 7 weeks after surgery. Urethroscopy confirmed that the urethra was not contracted, and computed tomography indicated that the tube was not continuous with partially deflated pressure-regulating balloon (PRB). On reoperation, the tube was found to be disconnected at the intended point of connection. By refilling PRB and performing urethroscopy, we confirmed the PRB without leakage and good urethral cuff coaptation, respectively.The AUS replacement procedure was then completed with only the replacement of the control pump and reconnection of the tubing. After the surgery, AUS was immediately activated to confirm the improvement of SUI. After 3 months post-surgery, the patient have enjoyed urinary continence. If the defective part of the AUS system can be identified during replacement, the procedure can be completed with only partial replacement and without manipulation of the urethra, thus avoiding the risk of urethral injury.