The artificial urinary sphincter in 86 patients with intrinsic sphincter deficiency: satisfactory actuarial adequate function rates.

Abstract

To evaluate the long-term results of the AMS-800 artificial urinary sphincter (AUS) in patients with incontinence due to intrinsic sphincter deficiency, taking into account the continence status and the durability of the device. Between 1984 and 1997, an AUS was implanted in 86 patients. Kaplan-Meier survival analysis was used to determine the 'primary adequate function' rate (P-AF) and the 'additional procedure assisted adequate function' rate (APA-AF). These rates define adequate function as satisfactory continence (use of maximally 1 pad per 24 h) in combination with good AUS function. In the case of P-AF, no revisions have been required. In the case of APA-AF, one or more revisions of parts of the AUS are acceptable but a complete exchange or explantation of the AUS marks its endpoint. At last follow-up, satisfactory continence was found in 76% of the patients. Continence was markedly improved in another 7%. The 5-year P-AF and APA-AF rates were 46 and 67%, respectively. The 5-year P-AF rates for the periods before and after the introduction of the narrow backed cuff were 33 and 61%, respectively (p = 0.03). The AUS can give excellent results as far as urinary continence is concerned, but only at the expense of a considerable reoperation rate. The 5-year actuarial primary adequate function rate has almost doubled since the introduction of the narrow backed cuff design.