You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2016MP87-20 THE EFFICACY AND SAFETY OF PROXIMAL ARTIFICIAL URINARY SPHINCTER PLACEMENT IN REVISION CASES: A SINGLE INSTITUTION EXPERIENCE. Lanette Rickborn, Catherine Chen, Scott Swanson, and Christopher Wolter Lanette RickbornLanette Rickborn More articles by this author , Catherine ChenCatherine Chen More articles by this author , Scott SwansonScott Swanson More articles by this author , and Christopher WolterChristopher Wolter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2370AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-prostatectomy incontinence is a major concern for prostate cancer patients and can significantly decrease the quality of life. Artificial urinary sphincter (AUS) placement yields high success rates and patient satisfaction, and is considered the gold standard in treating this problem. However, revision surgeries are commonly needed for infection, erosion, atrophy/persistent incontinence, and mechanical failure. There are many different types of revisions, including cuff downsizing, distal placement, transcorporal placement, tandem cuff placement, and proximal placement. The purpose of this study is to evaluate the feasibility, efficacy and safety of proximal AUS placement in revision cases. METHODS A retrospective database of patients who underwent AUS placements from 1994-2015 by nine surgeons at a single institution was reviewed. Two surgeons performed the revision operations. The revision type, reason for revision, and stress urinary incontinence outcomes were evaluated. RESULTS A total of 213 AUS cases were performed from 1994 to 2015, with 185 cases done from 2008 to 2015 by 2 surgeons (SKS and CEW). 69 of these cases were revision cases. Of this group, 24 were proximal cuff placements and 20 were tandem cuff placements. Tandem cuffs were placed with at least one cuff proximal to the original cuff; thus, 64% (44/69) of the revisions consisted of proximally placed cuffs in some form. The other 36% consisted of downsizing (n=10), distal placement (n=6), transcorporal (n=3) and unspecified (n=6). 13 cases of 69 revision cases were second revisions. In this group, 3 cases were performed for device malfunction/loss of fluid, 1 for urethral atrophy, 8 for persistent urinary incontinence, and 1 for erosion. Excluding those done for device malfunction or fluid loss, 4 cases that were secondary revisions had proximal placement for their prior revision. Thus, 91% (40/44) of the proximally placed revisions were successful from a technical standpoint, and did not require or seek further treatment in this time period. CONCLUSIONS It is our belief that AUS revision works best when the replacement cuff is placed on a healthy segment of the urethra, rather than downsizing at the universally atrophic segment seen at the previous cuff site. The proximal urethra is often accessible and robust in size, allowing for increased expectations of success. Although proximal AUS revisions can be technically more challenging, they can be done safely with great success rates. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1122 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Lanette Rickborn More articles by this author Catherine Chen More articles by this author Scott Swanson More articles by this author Christopher Wolter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...