Device survival following primary implantation of the AMS 800 artificial urinary sphincter for male stress urinary incontinence

The AMS 800(TM) artificial urinary sphincter (AUS) remains the gold standard for the surgical management of male stress urinary incontinence. We reviewed AUS device survival following primary implantation.

Retrospective data was collected from the AMS 800(TM) patient information form (PIF) database. Since 1972, 77,512 PIFs for primary AUS implantation have been completed in the United States. Following exclusion of procedures performed in children and females, and those labeled with an unknown surgical technique, 27,096 AUS cases were included in the analysis. Collected variables included patient age, surgical approach, number of cuffs, and surgeon volume. Measured outcomes included device explantation, device revision, component revision, and time to each event.

AUS insertion was performed by low-volume implanters in 22,165 (82.6%) of cases. Approach was perineal in 18,373 cases (67.8%), and a tandem cuff was used in 2,224 cases (8.2%). Overall, 5,723 cases required either revision or explantation (21.1%). Younger age and penoscrotal approach were associated with higher device explantation and revision rates, while use of a tandem cuff was associated with higher explantation rates. On multivariate analysis, younger age, penoscrotal approach, and use of a tandem cuff, but not surgeon volume, were significant factors associated with device explantation and component revision.

These data provide a general overview on AUS device survival, and may serve urologists when counseling patients. Younger age, penoscrotal approach, and use of tandem cuff may be associated with inferior outcomes.

The Journal of urology. 2016 Sep 07 [Epub ahead of print]

Faysal A Yafi, Kenneth J DeLay, Carrie Stewart, Jason Chiang, Premsant Sangkum, Wayne J G Hellstrom

Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA., Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA. Electronic address: .