The AS 800 Artificial Urinary Sphincter: Surgical Technique and Troubleshooting
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The first artificial urinary sphincter was implanted in June 1972. Since then, significant advances have been made in both the design and reliability of the device. Faulty patient selection and/or surgical technique have now replaced mechanical problems as the most common cause of device failure. The current model, the AS 800, together with the improved silicone-coated cuff, has a low failure rate. A detailed description of patient selection is beyond the scope of this chapter. Briefly, however, the success with the artificial urinary sphincter in obtaining continence is definitely influenced by the presence of any bladder pathology. A “normal” bladder or detrusor areflexia with unaltered compliance is consistently associated with a high degree of success, approaching 90%. However, the presence of detrusor hyperreflexia, e.g. following spinal cord injury, or diminished compliance results in a much lower success rate of approximately 68% and 50%, respectively. Careful urodynamic evaluation is therefore essential to establish the bladder response to filling. It should be remembered that the artificial urinary sphincter substitutes for sphincteric incompetence and should not therefore be used solely to control aberrant detrusor behaviour. The decision as to whether to ablate any bladder outflow resistance rests with the implanting surgeon. The present author routinely performs a sphincterotomy in males or a bladder flap urethroplasty in females if outflow obstruction is documented on preoperative urodynamic evaluation. It is felt that the ability to urinate per urethra without having to resort to intermittent catheterisation achieves improved overall patient rehabilitation.
KeywordsBladder Neck Urologic Surgery Artificial Urinary Sphincter Retropubic Space Balloon Volume
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