title: Tulane experience with management of urinary incontinence after placement of an artificial urinary sphincter.
abstract: Persistent urinary incontinence following placement of an artificial urinary sphincter (AUS) presents a challenging diagnostic problem. This report reviews 30 cases (27 males and 3 females) involving urinary incontinence following AUS placement. The mean age of the patients was 64.4 years (range, 10-79 years). Physical examination demonstrated evidence or suspicion of infection or erosion in 7 patients, and subsequent cystoscopic examination revealed erosion caused by the cuff in 6 of these 7 cases. The remaining 23 patients were evaluated by videofluorourodynamics (VFUD) to ascertain the cause of incontinence. VFUD demonstrated detrusor instability in 9 patients (39%), low detrusor compliance in 3 patients (13%), and poor detrusor contractility in 1 patient (4.4%). Bladder-outlet obstruction was diagnosed in 2 patients (8.8%)-1 with bladder-neck contracture and 1 with ureteral stricture. Altogether, 2 (8.8%) cases of tissue atrophy were diagnosed with low urethral closing pressure at the cuff. In all, 1 patient (4.4%) was diagnosed as having a vesicovaginal fistula, 1 (4.4%) had a tubing kink, and 4 (17%) had leaking devices diagnosed during VFUD by cycling of the device. Of the 23 patients, 21 (91%) demonstrably improve or became fully continent after appropriate treatment had been initiated. A review of this study suggests that the majority of incontinent patients after AUS implantation can be managed successfully, provided that a systematic diagnostic approach is followed and appropriate treatment is initiated.
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112.
authors.forename: G M
authors.initials: GM
authors.lastname: Ghoniem
authors.forename: J
authors.initials: J
authors.lastname: Lapeyrolerie
authors.forename: O P
authors.initials: OP
authors.lastname: Sood
authors.forename: R
authors.initials: R
authors.lastname: Thomas
mesh_terms: D000465:Algorithms; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000000981:diagnostic imaging; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects; D014563:Urodynamics / Q000502:physiology; D014743:Videotape Recording