SUFU 2018: Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival

Austin, TX (  Dr. Arnav Srivastava presented on a stufy aimed to tabulate the causes of AUS failure requiring surgical revision, assess the survival characteristics of each component, and examine the efficacy of single-component revision.

Dr. Srivastava and colleagues had retrospectively reviewed 168 patients receiving AUS placements from 2008 – 2016. Patients requiring revision had either pressure-regulating balloon (PRB)-only correction or revision with cuff and PRB exchange. Bootstrapped intervals estimated mean time-to-failure for individual AUS components. Survival analysis using Kaplan Meier estimates compared individual component survival as well as device survival by revision technique. 

The median follow up was 2.7 years (IQR: 1.1, 5.9) with 63 patients (37.5%) requiring AUS correction. The most common cause of device failure was PRB malfunction (36.5% of all device failures), while cuff or pump malfunction was rare. Stratifying mechanical failure, device failure due to PRB malfunction occurred later (4.82 years after initial placement) than failures attributed to cuff (1.32 years) or pump malfunction (0.38 years) (p<0.05). Lastly, among patients undergoing surgical revision, those undergoing only PRB correction had similar outcomes to those cuff and PRB replacement (71.1% vs. 68.9% device survival at 2.5 years after first revision; p=0.46).

In conclusion the PRB malfunction is the most common cause of AUS failure in this cohort. PRB-only correction appears to satisfactorily restore AUS function in some patients. Consequently, initial interrogation of the PRB may spare patients a second incision and urethral exposure for many patients requiring AUS revision.

Presented by: Arnav Srivastava, BA, MPH
Co- Authors: Gregory Joice MD, Hiten Patel MD, MPH, Madeleine Manka MD, Nikolai Sopko MD, PhD and Edward Wright MD, Johns Hopkins Hospital, Baltimore, MD

Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas