title: Long-term results of artificial urinary sphincter for women with type III stress urinary incontinence.
abstract: BACKGROUND
  The use of the artificial urinary sphincter (AUS) in women is limited.
  
  
  OBJECTIVE
  To analyse long-term results and mechanical survival of the AUS (AMS 800; American Medical Systems, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD).
  
  
  METHODS
  Women with SUI who were treated between January 1987 and March 2007 were included in this prospective study. Only women with low closure pressure at urethral profile and negative continence tests, indicators of severe ISD, were included.
  
  
  METHODS
  An AUS was implanted. The surgical technique was modified in 1999, involving opening the endopelvic fascia on both sides and dissection in contact with the vaginal wall.
  
  
  METHODS
  Assessment of complications was made pre- and postoperatively and continence status was based on pad usage. Kaplan-Meier survival curves were used to calculate mechanical survival of the device. Student t test and the chi-square test were used to compare continence and complication rates.
  
  
  CONCLUSIONS
  A total of 376 AUS were implanted in 344 patients, whose mean age was 57 yr. The mean follow-up, plus or minus standard deviation, was 9.6±4.0 yr. At last follow-up, postoperative continence rates, assessed as fully continent (no leakage), socially incontinent (some drops but no pad), or incontinent (one pad or more), were 85.6%, 8.8%, and 5.6%, respectively. The 3-, 5-, and 10-yr device survival rates were 92.0%, 88.6%, and 69.2%, respectively. The mean mechanical survival was 176 mo (14.7 yr). Three risk factors for AUS survival were the number of previous incontinence surgeries, the presence of neurogenic bladder, and simultaneous augmentation enterocystoplasty. Principal limitation of the study is the absence of validated incontinence questionnaire.
  
  
  CONCLUSIONS
  The AUS provides excellent outcome in women with ISD, with low explantation rate and very good device survival.
authors.affiliation: Urology and Andrology Department, Academic Hospital Caremau, Montpellier Université I, Nîmes, France. pierre.costa@chu-nimes.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Costa
authors.forename: Gregoire
authors.initials: G
authors.lastname: Poinas
authors.forename: Kamel
authors.initials: K
authors.lastname: Ben Naoum
authors.forename: Khalid
authors.initials: K
authors.lastname: Bouzoubaa
authors.forename: Laurent
authors.initials: L
authors.lastname: Wagner
authors.forename: Laurent
authors.initials: L
authors.lastname: Soustelle
authors.forename: Michel
authors.initials: M
authors.lastname: Boukaram
authors.forename: Stéphane
authors.initials: S
authors.lastname: Droupy
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016741:Urinary Sphincter, Artificial