New & Old: Dr. Sean Elliott gave an excellent review of the Artificial Urinary Sphincter (AUS), touching on the history of the AUS, current use, and potential future changes in the technology. The AMS 800 (Boston Scientific, Marlborough, MA) is the gold standard and has been an excellent innovation in the field. Meta-analyses have shown that at 60 months, 80% of patients are still dry.
Complication rates remain low at five years with infections occurring in 2%, erosion in 5%, mechanical failure in 7%, and urethral atrophy in 7%.
Revision rate is 20% at 5 years and the half-life for the device is around 7.5 years.
The main issue with the current device is that the urethral pressure provided by the pressure regulating balloon cannot be titrated for stress activities, such as cough or exercise.
He then went on to describe the devices currently in development that may address this issue. Many of these devices will have the ability to be adjusted, either by a urologist adding or removing fluid to the device or by an adjustable cuff that will be Bluetooth activated with a variety of settings. Some also have an additional stress relief balloon designed to provide additional urethral pressure with any increase in intra-abdominal pressure.
Dr Elliott ended his talk by concluding that the AUS has already made a significant difference in the treatment of urinary incontinence, but that there is the potential for even more improvement as new devices are developed.
Written by: Lisa Parrillo,MD. University of Pennsylvania, AUA 2016 San Diego, CA.