title: Urethral atrophy after artificial urinary sphincter placement: is cuff downsizing effective?
abstract: OBJECTIVE
  We reviewed the outcome of cuff downsizing with an artificial urinary sphincter for treating recurrent incontinence due to urethral atrophy.
  
  
  METHODS
  We analyzed the records of 17 patients in a 7-year period in whom clinical, radiological and urodynamic evidence of urethral atrophy was treated with cuff downsizing. Cuff downsizing was accomplished by removing the existing cuff and replacing it with a 4 cm. cuff within the established false capsule. Incontinence and satisfaction parameters before and after the procedure were assessed by a validated questionnaire.
  
  
  RESULTS
  Mean patient age was 70 years (range 62 to 79). Average time to urethral atrophy was 31 months (range 5 to 96) after primary sphincter implantation. Mean followup after downsizing was 22 months (range 1 to 64). Cuff downsizing caused a mean decrease of 3.9 to 0.5 pads daily. The number of severe leakage episodes decreased from a mean of 5.4 to 2.1 The mean SEAPI (stress leakage, emptying, anatomy, protection, inhibition) score decreased from 8.2 to 2.4. Patient satisfaction increased from 15% to 80% after cuff downsizing. In 1 patient an infected cuff required complete removal of the device.
  
  
  CONCLUSIONS
  Patient satisfaction and continence parameters improved after cuff downsizing. We believe that this technique is a simple and effective method of restoring continence after urethral atrophy.
authors.affiliation: Department of Urology, University of California-Davis, Sacramento, California, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Saffarian
authors.forename: Kilian
authors.initials: K
authors.lastname: Walsh
authors.forename: Ian K
authors.initials: IK
authors.lastname: Walsh
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Stone
mesh_terms: D000368:Aged; D001284:Atrophy / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D014521:Urethra / Q000473:pathology*; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*