title: Decreasing need for artificial urinary sphincter revision surgery by precise cuff sizing in men with spongiosal atrophy.
abstract: OBJECTIVE
  Many patients with persistent incontinence after an artificial urinary sphincter procedure gain improved continence after cuff downsizing. In 2010 a new, smaller (3.5 cm) artificial urinary sphincter cuff was introduced. We hypothesized that men with spongiosal atrophy previously treated with a 4.0 cm cuff would now show a decreased rate of revision surgery due to more accurate cuff sizing.
  
  
  METHODS
  We evaluated the outcome in men who received identical 4.0 cm cuff sizes in 2 eras, before (2007 to 2009) and after (2010 to 2013) the introduction of the 3.5 cm artificial urinary sphincter cuff. Patients with a history of cuff erosion or those undergoing tandem, transcorporal, or 4.5 cm or greater cuff placement were excluded from analysis. We validated our institutional results using the nationwide AMS® PIF (Patient Information Form) database from identical time frames.
  
  
  RESULTS
  Of 236 men who underwent artificial urinary sphincter placement at our institution during the study period 170 with a mean age of 67 years met study inclusion criteria, of whom 88 (52%) received a 4.0 cm artificial urinary sphincter cuff. Mean followup was 34 months. Ten of 45 patients (22.2%) who had a 4.0 cm cuff placed from 2007 to 2009 required cuff downsizing for persistent incontinence while only 2 of 43 (4.7%) who received a 4.0 cm cuff from 2010 to 2013 required revision (p <0.001). Nationally patients with a 4.0 cm cuff underwent fewer revisions during the latter era (16.2% vs 7.5%, p = 0.001). In local and national cohorts Kaplan-Meier analysis revealed improved survival of the 4.0 cm cuff after the introduction of the 3.5 cm cuff (p <0.05).
  
  
  CONCLUSIONS
  The incidence of artificial urinary sphincter revision surgery in patients with a 4.0 cm cuff has decreased since the availability of the 3.5 cm cuff. This suggests that precise cuff sizing appears to be beneficial in men with spongiosal atrophy.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: allen.morey@utsouthwestern.edu.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: J Francis
authors.initials: JF
authors.lastname: Scott
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hudak
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Mazzarella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D061827:Dimensional Measurement Accuracy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014521:Urethra / Q000473:pathology*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D055815:Young Adult
keywords: artificial; atrophy; reoperation; stress; urethra; urinary incontinence; urinary sphincter