Artificial Urinary Sphincters: Reoperative Techniques and Management of Complications

Abstract

Male stress incontinence is a relatively common and treatable condition which significantly impacts quality of life. For over 40 years, the artificial urinary sphincter (AUS) has remained the gold standard therapy for moderate to large volume male stress urinary incontinence. Patients being considered for AUS placement should undergo a full preoperative history and physical examination with further studies, as clinically indicated. Despite excellent first-time success rates, a percentage of men managed with AUS will experience complications including urinary retention, urethral atrophy, erosion, and device malfunction, among others. Available surgical options for patients with either recurrent incontinence following initial AUS placement or those with prior AUS complications include placement of a tandem cuff, transcorporal cuff, cuff downsizing, reservoir upsizing, or tissue interposition with AUS. Here-in is a review of the available literature, as well as a clinical guide to management of AUS complications, and a visual and descriptive overview of reoperative techniques. In addition to technical advancements with the AUS, ongoing research with salvage therapies will continue to improve outcomes for patients experiencing stress incontinence.