title: Revision Techniques After Artificial Urinary Sphincter Failure in Men: Results From a Multicenter Study.
abstract: OBJECTIVE
  To compare the results of various single-component artificial urinary sphincter (AUS) revision techniques for continued/recurrent stress urinary incontinence (SUI). Although AUS placement for male SUI has a high rate of success, revisions may be performed for mechanical failure of an isolated component or continued/recurrent SUI.
  
  
  METHODS
  From 1993 to 2012, 90 AUS revisions including urethral cuff downsizing (19), pressure-regulating balloon replacement (18), cuff repositioning (11), or tandem cuff placement (42) were performed at 2 institutions. End points included reoperation, incontinence failure, and urethral erosion. The Kruskal-Wallis test was used to compare continuous variables, and the log-rank test was used to compare Kaplan-Meier curves.
  
  
  RESULTS
  Mean age was 70.2 years, and median follow-up was 33.6 months. Median time to revision was 28.9 months. Tandem cuff placement was associated with a lower rate of incontinence failure (P = .02), whereas cuff repositioning was associated with a higher rate of incontinence failure (P = .02). An increased rate of mechanical failure was observed with cuff downsizing (P = .01). Among options for revision (1) cuff downsizing is associated with a higher rate of mechanical failure, and (2) cuff repositioning with the same size is associated with a higher rate of incontinence failure, whereas (3) tandem cuff placement is associated with a lower rate of recurrent SUI compared to other types of AUS revision.
  
  
  CONCLUSIONS
  Cuff repositioning is associated with an increased rate of persistent incontinence after AUS revision whereas tandem cuff placement is associated with a lower rate of recurrent or persistent incontinence.
authors.affiliation: Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: jeswara@partners.org.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
authors.affiliation: Department of Urology, Houston Methodist Hospital, Houston, TX.
authors.forename: Robert
authors.initials: R
authors.lastname: Chan
authors.affiliation: Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: H Henry
authors.initials: HH
authors.lastname: Lai
authors.affiliation: Department of Urology, Houston Methodist Hospital, Houston, TX.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Boone
authors.affiliation: Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects*; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial