title: A prospective study evaluating the efficacy of the artificial sphincter AMS 800 for the treatment of postradical prostatectomy urinary incontinence and the correlation between preoperative urodynamic and surgical outcomes.
abstract: OBJECTIVE
  We have evaluated prospectively the long-term efficacy of the artificial urinary sphincter (AUS) AMS 800 for the treatment postradical prostatectomy urinary incontinence (PRPUI) patients. We also evaluated the correlation between preoperative urodynamic findings and surgical outcomes.
  
  
  METHODS
  From May 1997 to April 2003, 40 consecutive patients with PRPUI caused by intrinsic sphincter deficiency (ISD) were treated with the AMS 800. Mean age was 68.3 +/- 6.3 years. Continence status was evaluated on the basis of pad count, impact of urinary incontinence on the quality of life, complications, and surgical revisions. Preoperative urodynamic findings were correlated with surgical outcomes.
  
  
  RESULTS
  Follow-up ranged from 27 to 132 months (mean = 53.4 +/- 21.4 months). There was a significant reduction in pad count from 4.0 +/- 0.9 to 0.62 +/- 1.07 diapers per day (P <0.001) leading to continence in 90%. There was a significant reduction on the impact of incontinence decreasing from 5.0 +/- 0.7 to 1.4 +/- 0.93 (P <0.001) in a visual analogue scale (VAS). Surgical revision rate was 20%. Preoperative urodynamics was useful to identify sphincter deficiency. Except by a tendency of worse results in patients with reduced bladder compliance (RBC), other urodynamic parameters did not correlate with a worse surgical outcome.
  
  
  CONCLUSIONS
  The AMS 800 offers good long-term continence to most PRPUI patients. Preoperative findings like detrusor hyperactivity (DH), impaired detrusor contraction (IDC), low Valsalva leak point pressure, bladder outlet obstruction (BOO), and mild RBC were not associated with worse surgical outcomes.
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. flaviotrigo@uol.com.br
authors.forename: Flavio
authors.initials: F
authors.lastname: Trigo Rocha
authors.forename: Cristiano Mendes
authors.initials: CM
authors.lastname: Gomes
authors.forename: Anuar Ibrahim
authors.initials: AI
authors.lastname: Mitre
authors.forename: Sami
authors.initials: S
authors.lastname: Arap
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011788:Quality of Life; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics