title: A comparison of the functional durability of the AMS 800 artificial urinary sphincter between cases with and without an underlying neurogenic aetiology.
abstract: OBJECTIVE
  To compare the efficacy and functional durability of the American Medical Systems 800 (AMS 800) artificial urinary sphincter (AUS) device for patients with neurogenic and non-neurogenic incontinence.
  
  
  METHODS
  From 1985 to 2000, 38 patients underwent implantation of an AMS 800 AUS at our institution. Thirty of these patients had complete records and follow-up data available. The mean follow-up for these two groups of patients was six years. Seventeen devices (57%) were implanted for non-neurogenic indications including incontinence after prostatectomy or hysterectomy. Thirteen devices (43%) were implanted for neurogenic conditions including spina bifida, spinal cord injury or severe pelvic trauma. The primary end point measured was continence. Secondary end points included mechanical and non-mechanical device failure, re-operation and complication rates between the two groups.
  
  
  RESULTS
  In the neurogenic group, only two patients (15%) have their original device in situ without revisions. Only three patients (23%) in this group are entirely dry. In contrast, seven patients (41%) in the non-neurogenic group are completely dry with their original device in situ. A further four (23%) are entirely dry after device revision or replacement surgery. The rates of mechanical failure were not statistically different between the two groups. The rate of non-mechanical failure (NMF) was statistically greater in the neurogenic group in comparison to that in the non-neurogenic group (p < 0.05).
  
  
  CONCLUSIONS
  Insertion of an AMS 800 artificial sphincter remains a durable means of regaining urinary continence. Patients who are incontinent as a result of an underlying neurological deficit should be counselled that they might have a higher risk of non-mechanical device failure, requirement for re-operation and that their overall long-term continence rates may be poor.
authors.affiliation: Department of Urology, Adelaide Hospital, Tallaght, Dublin, Ireland. smurphy@bccancer.bc.ca
authors.forename: S
authors.initials: S
authors.lastname: Murphy
authors.forename: D
authors.initials: D
authors.lastname: Rea
authors.forename: J
authors.initials: J
authors.lastname: O'Mahony
authors.forename: T E D
authors.initials: TE
authors.lastname: McDermott
authors.forename: J
authors.initials: J
authors.lastname: Thornhill
authors.forename: M
authors.initials: M
authors.lastname: Butler
authors.forename: R
authors.initials: R
authors.lastname: Grainger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial