MP88-18 DOES USE OF A SECOND CUFF IMPROVE ARTIFICIAL SPHINCTER EFFECTIVENESS? EVALUATION USING A COMPARATIVE CADAVER MODEL

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-18 DOES USE OF A SECOND CUFF IMPROVE ARTIFICIAL SPHINCTER EFFECTIVENESS? EVALUATION USING A COMPARATIVE CADAVER MODEL Madeleine Manka and E. James Wright Madeleine MankaMadeleine Manka More articles by this author and E. James WrightE. James Wright More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The artificial urinary sphincter (AUS) has long been recognized as the most effective long-term solution for men with severe stress incontinence. It is widely believed that inserting a second (tandem) urethral cuff can improve device efficacy, but this supposition is backed by little empirical evidence. In this study, we directly compare the functionality of a single versus tandem cuff in a cadaver model. METHODS The AUS reservoir pressure was confirmed to be between 61-70 cm H2O via burette test. The bulbar urethra was dissected using a perineal approach in each cadaver (n=4). The resting urethral circumference of the distal and proximal bulbar urethra was measured. The membranous urethra was transected. Appropriately sized occlusive cuffs were placed in the distal and proximal positions and connected to the pressure reservoir and control pump. Retrograde leak point pressure (RLPP) was measured sequentially across the distally placed single cuff, the proximally placed single cuff, and two tandem cuffs by inserting a catheter in the occluded urethra and raising an attached bag of fluid until leakage was seen across the transected urethra. The height between the fluid and cuff was recorded (cm H2O). A Friedman test was used to compare RLPP between the three cuff configurations, a paired t test to compare distal and proximal urethral circumference, and a Pearson correlation to compare urethral circumference to RLPP. RESULTS Mean RLPP across the distal, proximal and tandem cuffs was 70.25, 77.75, and 76.75 cm H2O respectively (p=0.14). Mean urethral circumference of the distal and proximal bulbar urethra was 4.78 and 5.83 cm respectively (p =0.019). There was a strong positive correlation between urethral circumference and RLPP (r = 0.75). CONCLUSIONS The tandem cuff does not appear to improve leak point pressure. In addition, the proximal bulbar urethral circumference (below the crus) was found to be significantly greater than the distal urethral circumference. Increasing urethral circumference was strongly correlated with an increase in the pressure needed to overcome cuff occlusion (RLPP). Therefore, it would appear that the perceived benefit of a second urethral cuff reflects function of the more proximal cuff alone. In our model, a tandem cuff did not increase effectiveness of the AUS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1098-e1099 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madeleine Manka More articles by this author E. James Wright More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...