MP38-11 LONG-TERM FOLLOWUP COMPARISON OF VARIOUS ARTIFICIAL URINARY SPHINCTER REVISION METHODS

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy II1 Apr 2014MP38-11 LONG-TERM FOLLOWUP COMPARISON OF VARIOUS ARTIFICIAL URINARY SPHINCTER REVISION METHODS Jairam Eswara, Robert Chan, Joel Vetter, Henry Lai, Timothy Boone, and Steven Brandes Jairam EswaraJairam Eswara More articles by this author , Robert ChanRobert Chan More articles by this author , Joel VetterJoel Vetter More articles by this author , Henry LaiHenry Lai More articles by this author , Timothy BooneTimothy Boone More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1268AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study is to compare the long-term results of patients who underwent artificial urinary sphincter (AUS) revision for recurrent or continued urinary incontinence. METHODS From 1988-2012, 89 AUS revisions were performed at 2 institutions. AUS revision including urethral cuff downsizing, replacement of the pressure-regulating balloon (PRB), cuff repositioning, or tandem cuff placement was performed for recurrent or persistent SUI. Of the 89 original surgeries, cuff sizes were 3.5cm (2), 4.0 (76), 4.5 (11), and all used a 61-70cm H2O PRB. The endpoints were reoperation or worsening stress urinary incontinence (the use of pads) as described by the patient. Student’s t-test was used to compare continuous normally distributed variables, and Kaplan-Meier curves were compared using the log rank test. RESULTS Revision methods to correct continued SUI included the following: urethral cuff downsizing to 3.5cm (14) and to 4.0cm (4), replacement of the 61-70cm H2O PRB to 71-80cm H20 (19), cuff repositioning (10), and tandem cuff placement (42). Mean age was 67.9 years and median follow-up was 35.2 months. Median time to revision was 33.2 months. Patients who underwent cuff downsizing for continued incontinence had a higher rate of mechanical failure compared to all other forms of AUS revision (p=0.016). No increased rate of urethral erosion was observed between the two groups (p=0.244). There was no significant difference among the AUS revision groups with regard to incontinence failure (p=0.313), mechanical failure (p=0.310), urethral erosion (p=0.448), or overall failure (p=0.336). When assessed individually, none of the revisions was associated with a higher rate of incontinence failure compared to the rest of the cohort: cuff downsizing (p=0.137), PRB replacement (p=0.737), cuff repositioning (p=0.354), and tandem cuff placement (p=0.146). CONCLUSIONS AUS cuff downsizing for recurrent or persistent SUI is associated with a higher rate of mechanical failure and thus is a less desirable salvage method if alternatives are possible. In the properly selected patient all other revision methods, including PRB replacement, cuff repositioning, or tandem cuff placement are equally safe, effective, and durable. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e404-e405 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jairam Eswara More articles by this author Robert Chan More articles by this author Joel Vetter More articles by this author Henry Lai More articles by this author Timothy Boone More articles by this author Steven Brandes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...