AUA 2018: Bladder Neck Artificial Urinary Sphincter for Recurrent or Complex Primary Urodynamically Proven Stress and Mixed Urinary Incontinence

San Francisco, CA ( The management of recurrent and complex stress urinary incontinence (SUI) presents multiple challenges, particularly in cases where more standard approaches fail or in which anatomical abnormalities exist. Eabhann O'Connor, MD presented data from the University College London Hospitals (UCLH) describing the outcomes of bladder neck artificial urinary sphincter (BN AUS) in females for the management of recurrent or complex primary urodynamically proven SUI and stress-predominant mixed urinary incontinence (MUI). Much research regarding the efficacy and safety of artificial urinary sphincters (AUS) exists in males, but the literature of AUS in females is more limited. 

The authors described the complex histories of patient selected to undergo BN AUS implantation, including neurological etiologies (17), recurrent stress urinary incontinence (16), epispadias (6), pelvic fracture urethral injury (4), bilateral single ectopic ureter (3), urethrovaginal fistula (1), augmentation urethroplasty (1), congenital Mullerian anomaly (1), and a history of an undiversion (1). 43/50 (86%) had a history of a previous surgery including cystoplasty, undiversion, urethroplasty, urethrovaginal fistula repair, and anti-incontinence surgery.

The BN AUS implantation was catered to each patient. 25 patients underwent a single-stage procedure with implantation of all device components; 21 women had a staged procedure in which the bladder neck cuff was implanted at the first procedure and the remaining components were implanted and the device activated six months later; and 4 patients had implantation of the bladder neck cuff alone, as the cuff itself was found to result in resolution of their incontinence. 

Complication rates were reported. 8% of the study population required component repositioning, 4% had a mechanical malfunction of the device, and 6% experienced an acute device infection, and 16% developed chronic infections or device erosion. The 11 patients (22%) with infection or erosion of the BN AUS required explantation of the device. The authors remarked that erosion tended to occur within the first few weeks of insertion, and they considered the device stable if there were no complications within 2 years of implantation. 

Bladder Neck Artificial Urinary Sphincter AUA2018

The authors reported that of the 78% of women with functioning devices during follow-up, 38% of patients required clean intermittent catheterization following the procedure. 85% of patients were dry with the BN AUS, 10% had improved SUI, and 5% continued to experience SUI. Of the 2 patients who remained incontinence, both had congenital anatomical abnormalities of the lower urinary tract. Only 1 patient (2%) in the study reported new onset detrusor overactivity. 

The authors concluded that BN AUS implantation provides a useful and effective treatment option in patients with complex or recurrent SUI. In this highly selected group of patients, there was a low acute infection/erosion rate of 6%, although there was a higher risk (22%) of chronic infection and erosion. 

Presented by: Eabhann O'Connor, MD, University College London Hospitals, London, United Kingdom
Co-Authors: Dunia Benamer, Jeremy Ockrim, Tamsin Greenwell, Daniela Andrich, Anthony Mundy, London, United Kingdom

Written by:  Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA