Post-Prostatectomy incontinence and the Artificial Urinary Sphincter: A Long-Term Study of Patient Satisfaction and Criteria for Success

Abstract

Purpose We investigated patient satisfaction with the artificial urinary sphincter and established criteria for a successful outcome by inquiring about patient perceived satisfaction, continence achieved and comparison with the surgeon office records. Materials and Methods During 9 years 65 patients with post-prostatectomy incontinence underwent placement of the AMS800 * * American Medical Systems, Minnetonka, Minnesota. artificial urinary sphincter. Review of charts and a telephone questionnaire were conducted to determine patient perceived satisfaction. Results A total of 50 patients participated in the survey. Median followup was 23.4 months. Preoperative incontinence was severe. Of the patients 90 percent reported continuous leakage, and 70 percent wore an average of 6 diapers and 24 percent wore an average of 7.4 pads daily. The long-term complete continence rate was 20 percent. Of the patients with wetness 55 percent had leakage of a few drops daily and 22 percent had leakage of less than a teaspoon. Of all patients 50 percent had leakage daily, 24 percent had leakage 1 or more times a week and wore an average of 1.5 pads per day, and 6 percent reported changing clothes due to wetness. A total of 90 percent of the patients reported satisfaction with the artificial urinary sphincter and 96 percent stated that they would recommend or had recommended the artificial urinary sphincter to a friend. In retrospect, 92 percent of the patients would have the artificial urinary sphincter placed again, 90 percent of those undergoing revision reported no change in satisfaction and 14 percent reported improved sexual activity. Conclusions Patient satisfaction with the artificial urinary sphincter for post-prostatectomy incontinence is uniformly high. Although postoperative continence was not 100 percent, relative improvement in continence was the most significant factor affecting patient perceived outcome. Using these parameters criteria for a successful outcome can be established, and patient concerns regarding the artificial urinary sphincter can be dispelled.