Implantation of an artificial urinary sphincter for urinary incontinence after radical prostatectomy (current aspects)

Abstract

Stress urinary incontinence is a debilitating condition for men, caused in most cases by radical prostatectomy. Implantation of an artificial urinary sphincter is the “golden standard” of operative correction of this pathological condition in intermediate and severe cases. The article present literature review on comparative effectiveness and safety of implantation of an artificial urinary sphincter in men.The study objective is to study the current concepts of implantation of an artificial urinary sphincter in males, as well as its effectiveness and safety.Literature search was performed using PubMed/Medline and SCOPUS databases with the following key words: stress urinary incontinence, radical prostatectomy, artificial urinary sphincter. Inclusion criteria for the studies were follow-up longer than 12 months and definition of successful result as use of 1 or less liner a day; current studies on effectiveness of prosthesis implantation with large patient population were also included. Special focus was made on the historical development of artificial sphincters, problems of comparison of the effectiveness of male slings and artificial urinary sphincter, as well as simultaneous implantation of a sphincter and a penile prosthesis. We have used 43 articles complying with the inclusion criteria, our aim, and objectives.In the considered literature, effectiveness and safety of implantation were studied primarily (70 %) for the AMS 800 implant. It was noted that the frequency of revisions of its implantation can reach 30 %. For other models of artificial sphincters, the data is sparce. Comparison of the effectiveness of artificial sphincter and male sling implantations mostly was performed for patient groups with incomparable severity of urinary incontinence. Patients’ preferences and cost had the largest effect on the choice of single-step or subsequent implantation of a penile prosthesis and an artificial urinary sphincter.Implantation of АМS 800 is an effective but not perfectly safe method of operative treatment of stress urinary incontinence in males. Development and study of new prostheses of this category are necessary.