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The AS 800 Artificial Urinary Sphincter: Surgical Technique and Troubleshooting

  • J. K. Light
Chapter
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Part of the Clinical Practice in Urology book series (PRACTICE UROLOG)

Abstract

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.

Keywords

Bladder Neck Urologic Surgery Artificial Urinary Sphincter Retropubic Space Balloon Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Further Reading

  1. Holm-Bentzen M, Klarskov P, Opsomer R, Maegaard EM, Haid T (1985) Objective assessment of urinary incontinence after successful implantation of the AMS artificial urethral sphincter. Neurourol Urodynam 4: 9–13CrossRefGoogle Scholar
  2. Light JK (1985) The artificial urinary sphincter in children — experience with the AS800 series and bowel reconstruction. Urol Clin North Am 12: 103–109PubMedGoogle Scholar
  3. Light JK, Scott FB (1983a) Use of the artificial urinary sphincter in spinal cord injury patients. J Urol 130: 1127–1129PubMedGoogle Scholar
  4. Light JK, Scott FB (1983b) Complications of the artificial urinary sphincter in pediatric patients. Urol Clin North Am 10: 551–555PubMedGoogle Scholar
  5. Light JK, Scott FB (1984) The artificial urinary sphincter in children. Br J Urol 56: 54–57PubMedCrossRefGoogle Scholar
  6. Light JK, Scott FB (1985) Use of the artificial urinary sphincter in stress incontinence. J Urol 134: 476PubMedGoogle Scholar
  7. Scott FB, Bradley WE, Timm GW (1973) Treatment of urinary incontinence by implantable prosthetic sphincter. Urology 1: 252–259PubMedCrossRefGoogle Scholar
  8. Scott FB, Light JK, Fishman IJ (1983) Postprostatectomy incontinence. The artificial sphincter. In: Hinman F Jr. (ed) Benign prostatic hypertrophy. Springer, Berlin Heidelberg New York, pp 1008–1022CrossRefGoogle Scholar
  9. Webster GD, Sihelnik SA (1984) Troubleshooting the malfunctioning Scott artificial urinary sphincter. J Urol 131: 269–272PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • J. K. Light

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