Abstract: PD64-10
Sources of Funding: none

Introduction

Implantation of the artificial urinary sphincter (AUS) around the bladder neck (or prostate in men) remains the goldstandard treatment for women with refractory sphincter weakness incontinence (SWI) or patients with neuropathic pathology. This study evaluates long-term outcomes of the AMS800 device in this patient population.

Methods

Over a 20 year period (January 1995 - December 2014), 140 bladder neck (BN) AUS were implanted in 111 patients (mean age 39.1 years) by a single surgeon. Aetiology of incontinence: Spina bifida n=53, neuropathic (other) n=15, failed female incontinence surgery n=22, pelvic fracture n=18, extrophy/epispadias n=15, following undiversion cystoplasty n=6, other n=4. 73 were primary procedures, 18 revision after previous infection/erosion and 49 replacement for malfunction. Mean follow-up was 112.8 months (range 12.4 - 243.7 months).

Results

55 of 140 (39.3%) devices were explanted at a mean of 39.1 months; 26 for erosion (50.4 months), 22 for malfunction (65.1 months), 7 for infection (1.5 months). 30 of 73 (41.1%) primary, 8 of 18 (44.4%) revision and 17 of 49 (34.7%) replacement implants were explanted. 118 devices were implanted in a single stage (n=51, 43.2% explanted) while 22 were done as a staged procedure (n=4, 18.2% explanted). In 68 cases patients performed self catheterisation (ISC) with the device explanted in 25 (37.3%) compared to 30 of 72 (41.4%) with no ISC. Interestingly, with ISC there was a much lower rate of erosion then no ISC (10% vs 26%) but a much higher malfunction rate (24% vs 8%). Cystoplasty was present in 67 cases of which 26 (38.8%) were explanted compared to 73 with no cystoplasty in which 31 (42.3%) were explanted. _x000D_ _x000D_ 85 devices (66.6%) remain in situ (42 primary, 10 revision, 33 replacement). 78 (91.8%) are keeping their users continent and happy with the outcome of their surgery. 2 of these, done as a staged procedure, are continent with only the cuff in situ. The other 7 are incontinent due to failure of the surgery or de novo detrusor overactivity. _x000D_

Conclusions

Apart from being more surgically challenging, implantation of a bladder neck AUS is associated with excellent functional outcomes albeit with a significantly higher explantation rate when compared to bulbar AUS. Contrary to what we have previously demonstrated with bulbar AUS, we have hereby shown no difference in explantation rate between primary and non-primary bladder neck AUS. The overall explantation rate is no difference whether a cystoplasty is present or not or whether patients performing ISC. ISC is nonetheless associated with a significantly higher rate of device malfunction.

Funding

none