Indications for revision of artificial urinary sphincter and modifiable risk factors for device-related morbidity.
OBJECTIVE
The aim of the study is to evaluate the causes for artificial urinary sphincter (AUS) failure in a contemporary series, and to detect modifiable risk factors for device-related complications. The aim is to also report outcome after AUS revision.


METHODS
We retrospectively reviewed the medical records of consecutive patients who underwent AUS revision at a tertiary care institution by a single surgeon from 2006 to 2011. There were 53 AUS revisions performed on 34 patients at a median age of 69 years.


RESULTS
Urethral atrophy was the most common indication for revision. Fourteen patients (41%) underwent more than one revision. Seven patients had urethral catheterization in the setting of an active AUS while admitted to a non-urologic service; these patients all developed cuff erosion. Fifty-four percent of urethral erosions were associated with such traumatic catheterizations. After revision, 80% of patients with an AUS in place were using one or no pad daily at mean follow up of 27 months.


CONCLUSIONS
Urethral atrophy remains the most common reason for AUS revision. More than half of all urethral erosions are secondary to urethral catheterization in the setting of an active sphincter, suggesting that some of the risk of device-related morbidity may be modifiable.
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, Maryland 21224, USA. imegwal1@jhmi.edu
Ifeanyichukwu I
II
Anusionwu
E James
EJ
Wright
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000150:complications / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery; D016741:Urinary Sphincter, Artificial