Artificial Urinary Sphincter Revision For Recurrent Incontinence: Single Component Replacement Is Both Feasible And Efficacious

Artificial Urinary Sphincter (AUS) placement is the gold-standard for moderate to severe post-prostatectomy stress urinary incontinence. Up to 50% of patients will require AUS revision due to recurrent incontinence secondary to mechanical failure or urethral atrophy. However, it is controversial if single component revision is feasible and effective or if the entire device should be replaced. We retrospectively identified 168 patients from 2008-2016 receiving an AUS from a single surgeon. Patients were presumed to have a functional AUS until they presented for recurrent incontinence or at last review of the database. During AUS revision, the pressure regulating balloon (PRB) was interrogated and if defective replaced. If the PRB was functional, it was left in-situ and the additional components interrogated with only the defective part replaced. Revisions were performed as outpatient procedures and devices left active unless the pump was replaced. At a median follow-up of 2.7 years, 63 patients (37.5%) required revision. The most common cause of AUS failure was PRB malfunction (36.5%) followed by urethral atrophy (22.2%). History of adjuvant radiation and prior sling placement were predictive of failure. On Kaplan-Meier analysis, PRB (84.3%) had significantly shorter survival at 5 years compared to urethral cuff (95.9%) and control pump (96.6%). Patients who underwent single component PRB replacement had similar device survival compared to a total AUS replacement (2.5 year survival: 71.1% vs. 87.5%, p =0.20).