Date Published: March 26, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Drogo K. Montague.
The published evidence concerning the safety, efficacy, and patient satisfaction for implantation of the current model of the artificial urinary sphincter (AS 800) in men with post prostatectomy urinary incontinence was the objective of this review. A Pub Med English language literature search from 1995 to 2011 was performed. A majority of men who undergo AUS implantation for post prostatectomy urinary incontinence achieve satisfactory results (0 to 1 pad per day). Infection rates range from 0.46 to 7%, cuff erosion rates range from 3.8 to 10%, and urethral atrophy ranges from 9.6 to 11.4%. Kaplan-Meier 5 year projections for freedom from any reoperation were 50% for a small series and 79.4% for a larger series. Kaplan-Meier projections for freedom from mechanical failure were 79% at 5 years and 72% at 10 years. In another series 10 year projections for freedom from mechanical failure were 64%. Although the artificial urinary sphincter (AUS) is the gold standard for the treatment of this disorder, most men will continue to need at least one pad per day for protection, and they are subject to a significant chance of future AUS revision or replacement.
There is a wide range in the reported incidence of postradical prostatectomy urinary incontinence coming from individual series presumably due to inconsistent definitions of incontinence and differing modes of assessment. When large populations of postradical prostatectomy patients are surveyed, however, a more consistent pattern is observed. In a series of 1291 postprostatectomy patients, significant urinary incontinence persisted in 8.4% of men at eighteen months . In a more recent NEJM study of 557 men at 12 months after radical prostatectomy, 24% were using pads, and 8% classified this as a moderate or big problem . Urinary incontinence occurs less often after transurethral resection of the prostate being a significant problem in only 0.5% of 3885 men 2 months following surgery .
A PubMed English language literature search from 1995 through 2011 for keywords: artificial sphincter; urinary sphincter, artificial; prosthesis failure; prostatectomy/ae [adverse effects]; patient satisfaction; quality of life was performed. Thirteen articles were found where data relevant to patients with post prostatectomy incontinence could be separated from other AUS uses. These articles were examined to perform this paper.
Significant urinary incontinence following radical prostatectomy which persists for more than one year occurs in as many as 8% of men. Although the AUS is the gold standard for the treatment of this disorder, most men will continue to need at least one pad per day for protection, and they are subject to a significant chance of future AUS revision or replacement.