World Journal of Urology

, Volume 37, Issue 4, pp 647–653 | Cite as

Prospective analysis of artificial urinary sphincter AMS 800 implantation after buccal mucosa graft urethroplasty

  • Valentin Maurer
  • Phillip Marks
  • Roland Dahlem
  • Clemens Rosenbaum
  • Christian P. Meyer
  • Silke Riechardt
  • Margit FischEmail author
  • Tim Ludwig
Topic Paper



To analyze functional outcomes and complication rates of artificial urinary sphincter (AUS) implantation in patients who had undergone buccal mucosa graft urethroplasty (BMGU) beforehand.

Patients and methods

This prospectively maintained single-center database comprises data from 236 patients from 2009 to 2015 who underwent AUS implantation. A total of 17 patients after BMGU were available for analysis. Primary endpoints consisted of continence and complication rates. Continence was defined as no use of safety pads, social continence as < 2 pads per day. Stricture recurrence was defined as a decrease in uroflowmetry, a maximum flow rate < 10 ml/s or residual urine volume (> 100 ml). Kaplan–Meier analysis determined explantation-free survival.


Median follow-up was 24 months (interquartile range [IQR] 6–31 months). Indication for AUS implantation was severe urinary incontinence with a history of radical prostatectomy (RRP) in 8 (47.1%), trauma in 1 (5.9%) and TUR-P in 8 (47.1%) patients. Pelvic irradiation was reported in 13 (76.5%) cases. The median length of buccal mucosa graft for urethroplasty was 4 cm (3–5 cm). A double cuff was implanted in 14 patients (82.4%), 3 patients received a single cuff. Complete and social continence was achieved in 76.5% and 100% of the patients, respectively. There was no significant difference in complications and explantation-free survival (log-rank, p = 0.191) between patients who had undergone BMGU before AUS compared to patients with no history of BMGU.


According to the prospective follow-up data in a homogenous cohort, AUS implantation seems to be a viable, safe and effective therapeutic strategy for incontinence treatment despite previous BMGU.


AMS 800 Artificial urinary sphincter Buccal mucosa graft urethroplasty Reconstructive urology Postprostatectomy stress urinary incontinence 


Author contributions

VM and PM: Data Collection and Analysis, Project Development, Manuscript Writing. RD: Data Collection, Manuscript Editing. CR and CPM: Manuscript Editing. SR and MR: Manuscript Editing. TAL: Data Collection and Analysis, Project Development, Manuscript Editing.

Compliance with ethical standards

Conflict of interest

Margit Fisch and Roland Dahlem has served as consultant for Boston Scientific. All other authors declare they have no conflict of interest.

Ethical approval

All procedures performed in our studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Hu JC et al (2004) Predicting quality of life after radical prostatectomy: results from CaPSURE. J Urol 171(2 Pt 1):703–707. (discussion 707-8) CrossRefGoogle Scholar
  2. 2.
    Mandel P et al (2017) High chance of late recovery of urinary and erectile function beyond 12 months after radical prostatectomy. Eurol Urol. 71(6):848–850CrossRefGoogle Scholar
  3. 3.
    Resnick MJ et al (2013) Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med 368(5):436–445CrossRefGoogle Scholar
  4. 4.
    Thuroff JW et al (2011) EAU guidelines on urinary incontinence. Eur Urol 59(3):387–400CrossRefGoogle Scholar
  5. 5.
    Herschorn S (2008) The artificial urinary sphincter is the treatment of choice for post-radical prostatectomy incontinence. Can Urol Assoc J 2(5):536–539CrossRefGoogle Scholar
  6. 6.
    Van der Aa F et al (2013) The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol 63(4):681–689CrossRefGoogle Scholar
  7. 7.
    Gomha MA, Boone TB (2002) Artificial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis. J Urol 167(2 Pt 1):591–596Google Scholar
  8. 8.
    Raj GV, Peterson AC, Webster GD (2006) Outcomes following erosions of the artificial urinary sphincter. J Urol 175(6):2186–2190. (discussion 2190) CrossRefGoogle Scholar
  9. 9.
    Hoy NY, Rourke KF (2015) Artificial urinary sphincter outcomes in the “Fragile Urethra”. Urology 86(3):618–624CrossRefGoogle Scholar
  10. 10.
    McGeady JB et al (2014) Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol 192(6):1756–1761CrossRefGoogle Scholar
  11. 11.
    Brant WO et al (2014) Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology 84(4):934–938CrossRefGoogle Scholar
  12. 12.
    Schreiter F (1985) Bulbar artificial sphincter. Eur Urol 11(5):294–299CrossRefGoogle Scholar
  13. 13.
    Ahyai SA et al (2016) Outcomes of single- vs double-cuff artificial urinary sphincter insertion in low- and high-risk profile male patients with severe stress urinary incontinence. BJU Int 118(4):625–632CrossRefGoogle Scholar
  14. 14.
    Fichtner J et al (2004) Long-term outcome of ventral buccal mucosa graft urethroplasty for urethral stricture repair. Urology 64(4):648–650CrossRefGoogle Scholar
  15. 15.
    Guillaumier S et al (2017) Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence. Urol Ann 9(3):253–256CrossRefGoogle Scholar
  16. 16.
    Simhan J et al (2015) 3.5 cm artificial urinary sphincter cuff erosion occurs predominantly in irradiated patients. J Urol 193(2):593–597CrossRefGoogle Scholar
  17. 17.
    O’Connor RC et al (2008) Long-term follow-up of single versus double cuff artificial urinary sphincter insertion for the treatment of severe postprostatectomy stress urinary incontinence. Urology 71(1):90–93CrossRefGoogle Scholar
  18. 18.
    Schuettfort VM et al (2017) Transperineal reanastomosis for treatment of highly recurrent anastomotic strictures after radical retropubic prostatectomy: extended follow-up. World J Urol 35(12):1885–1890CrossRefGoogle Scholar
  19. 19.
    Sathianathen NJ, McGuigan SM, Moon DA (2014) Outcomes of artificial urinary sphincter implantation in the irradiated patient. BJU Int 113(4):636–641CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity Hospital Hamburg-EppendorfHamburgGermany

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