title: Small intestinal submucosa urethral wrap at the time of artificial urinary sphincter placement as a salvage treatment option for patients with persistent/recurrent incontinence following multiple prior sphincter failures and erosions.
abstract: OBJECTIVE
  Patients with persistent and/or recurrent stress urinary incontinence (SUI) after multiple artificial urinary sphincter (AUS) revisions for erosion and infection represent a very challenging treatment population. Available management options are limited, with poor overall outcomes. We assess another treatment option.
  
  
  METHODS
  A retrospective analysis was performed of 8 patients presenting with severe, recurrent incontinence after multiple prior failed AUS procedures. All patients were treated with small intestinal submucosa (SIS) "urethral wrap" with subsequent AUS cuff placement to provide additional urethral bulk and serve as a "buffer" between the cuff and urethra.
  
  
  RESULTS
  Eight patients (median age 76 years, range 55-81) presented with near-total (4-5 pads) to total urinary incontinence, having previously undergone a combined 19 AUS procedures with 6 tandem cuffs and 8 prior urethral erosions. At a median follow-up of 12.4 months, 38% (3/8) of patients were dry, requiring no pads. Three patients underwent AUS explantation for sphincter erosion (n = 2) and infection (n = 1). Two patients had recurrent incontinence, with one occurring after wrap revision for urinary retention. Patients with prior radiation accounted for 80% (4/5) of procedure failures. All patients had temporary postoperative urinary retention.
  
  
  CONCLUSIONS
  SIS urethral wrap with AUS placement for severe SUI after multiple previous AUS placements and erosion/infection is a viable treatment option in appropriately selected patients for this very complicated issue. However, because of the complexity of the underlying problem, patients should be counseled about the expected risks and outcomes of surgery.
authors: Department of Urology, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA.
authors: Landon
authors: L
authors: Trost
authors: Daniel
authors: D
authors: Elliott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D014521:Urethra / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016741:Urinary Sphincter, Artificial