Contemporary Review of Artificial Urinary Sphincters for Male Stress Urinary Incontinence.

Abstract

The most common cause of urinary incontinence in men after radical prostatectomy is intrinsic sphincter deficiency, which can affect long-term quality of life. The prevalence of stress urinary incontinence (SUI) after radical prostatectomy has been reported to be 2.5% to 90%. For patients with moderate to severe male SUI, the artificial urinary sphincter (AUS) is considered the gold standard in surgical treatment. To review the available literature on the development, patient selection, surgical technique, complications, and management of AUS for male SUI. A literature review was performed through PubMed from 1947 to 2015 regarding AUS for male SUI. To assess various surgical techniques related to AUS insertion, outcomes, and complications and to offer recommendations regarding management of complications. The AUS can be placed through a perineal or trans-scrotal incision, particularly in the setting of dual insertion of an AUS and an inflatable penile prosthesis. The most commonly used cuff is 4.0 cm. The efficacy of InhibiZone is debatable. Pressure-regulating balloons can be filled with saline or contrast material and can be placed in an orthotopic or an ectopic location. In a systematic review of the literature, dry or improved continence rates are achieved in 79% of patients, with 90% reporting satisfaction and improved quality-of-life index scores after surgery. The most common AUS complications include a nonfunctioning device, sub-cuff atrophy, erosion, and infection. These complications are managed by strategies such as cuff downsizing, tandem cuff placement, and explantation. Dual AUS and inflatable penile prosthesis insertion is feasible for patients with SUI and erectile dysfunction. The AUS is a durable and effective device for the management of SUI. Surgeons should be versed in the different device components, their potential complications, and their management.