title: Is the implantation of an artificial urinary sphincter with a large cuff in women with severe urinary incontinence associated with worse perioperative complications and functional outcomes than usual?
abstract: OBJECTIVE
  As the subsequent risks of complications and explantation increase with the size of the cuff, we aimed to assess functional outcomes after the implantation of an artificial urinary sphincter (AUS) with a large cuff (≥8 cm) in women with severe urinary incontinence.
  
  
  METHODS
  Fifty women underwent an AUS placement with a large cuff between 1984 and 2007. Forty-three (86%) had previously undergone anti-incontinence procedures. The AUS was implanted with an open surgical technique using a transverse abdominal approach. The cuff was placed around the bladder neck between the periurethral fascia and the vagina. Perioperative complications were reviewed. To assess the resolution of urinary incontinence, all patients were seen at 1, 3, 6 and 12 months and yearly thereafter.
  
  
  RESULTS
  The mean age was 59 ± 12.4 years (26-81). The mean BMI was 27.3 ± 5.1 (19-37). The mean pre-operative closure pressure was 19.1 ± 9.4 cmH(2)O (3-46). The mean hospital stay was 14.1 ± 5 days (5-28). The mean follow-up was 8 ± 5.6 years. Incontinence was completely resolved in 34 women (68%). The protective factors to avoid explantation were a number of gestations less than two (p = 0.04), a closure pressure higher than 19 cmH(2)O (p = 0.04) and a cuff size equivalent to 8 cm (p = 0.005).
  
  
  CONCLUSIONS
  Specific anatomical conditions can sometimes lead to AUS implantation with a large cuff with encouraging outcomes. Thus, surgeons should not be reluctant to place a large cuff when the situation requires it.
authors.affiliation: Academic Department of Urology,Groupe Hospitalo-Universitaire EST, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Revaux
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Elise
authors.initials: E
authors.lastname: Seringe
authors.forename: Vincent
authors.initials: V
authors.lastname: Misraï
authors.forename: Florence
authors.initials: F
authors.lastname: Cour
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics / Q000502:physiology