Long-term functional results of artificial urinary sphincter implantation in men

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Abstract

Introduction. Urinary incontinence after radical treatment of prostate cancer causes a significant negative impact on the quality of life. Patients with severe urinary incontinence are most commonly treated with artificial urinary sphincter (AUS) placement.

Aim. To evaluate the functional results of AUS implantation in patients with severe urinary incontinence at long-term follow-up.

Materials and methods. Between 2004 and 2023, the AUS was implanted in 62 patients with severe stress urinary incontinence. Urinary losses were assessed using a bladder diary. No need to use pads or use of no more than 1 safety pad per day ("social continence") was considered a success, while use of no more than 2 pads, or a reduction in urine loss of more than 50% was regarded as an improvement.

Results. The mean patient age at the time of AUS implantation was 67.4±8 years. Urinary incontinence was most often a complication of radical prostatectomy (61.3%). A history of radiation therapy, previous treatment of urethral stricture, and surgical procedures for urinary incontinence were noted in 14.5%, 48.4%, and 19.4% of patients, respectively. The median follow-up was 73.5 months (IQR 14.8–118.3 months). There was a significant decrease in median urine loss from 900 mL (IQR 700–1100 mL) to 7 mL (IQR 0-35 mL; p<0.05), and a decrease in the number of pads used per day from 7 (IQR 6–8) to 1 (IQR 0-2; p<0.05). The criterion for successful implantation was met in 69.4% of patients, while 43.5% of patients did not use pads. According to the correlation analysis, concomitant diabetes mellitus, history of radiation therapy, surgical treatment of the urethral stricture or urinary incontinence did not have any significant effect on functional results. In addition, there were no cases of AUS revision.

Conclusions. AUS placement in patients with severe stress urinary incontinence allows to achieve satisfactory functional results during long-term follow-up.

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About the authors

A. A. Tomilov

Botkin Hospital; Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: toandrei33@yandex.ru
ORCID iD: 0000-0001-9286-5930

Ph.D., assistant professor at the Department of Urology and Surgical Andrology, urologist at Moscow urological center

Russian Federation, Moscow; Moscow

E. I. Veliev

Botkin Hospital; Russian Medical Academy of Continuous Professional Education

Email: veliev64@gmail.com
ORCID iD: 0000-0002-1249-7224

Ph.D., MD, professor at the Department of Urology and Surgical Andrology of Russian Medical Academy of Continuous Professional Education, Head of the Department of Oncourology at Moscow urological center

Russian Federation, Moscow; Moscow

E. N. Golubtsova

Botkin Hospital; Russian Medical Academy of Continuous Professional Education

Email: engolubtsova@yandex.ru
ORCID iD: 0000-0001-6651-2955

Ph.D., associate professor at the Department of Urology and Surgical Andrology of Russian Medical Academy of Continuous Professional Education, urologist at Moscow urological center

Russian Federation, Moscow; Moscow

References

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Supplementary files

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2. Fig. 1. Causes of urinary incontinence RPE — radical prostatectomy, TURP — transurethral resection of the prostate gland, TPAE — transvesical adenomectomy.

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3. Fig. 2. Dynamics of urine loss volumes (A) and the number of pads used (B) before and after IMS installation

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4. Fig. 3. The device of the artificial urinary sphincter AMS 800

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