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Artificial urinary sphincters for male stress urinary incontinence: current perspectives

The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for po...

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Autores principales: Cordon, Billy H, Singla, Nirmish, Singla, Ajay K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938139/
https://www.ncbi.nlm.nih.gov/pubmed/27445509
http://dx.doi.org/10.2147/MDER.S93637
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author Cordon, Billy H
Singla, Nirmish
Singla, Ajay K
author_facet Cordon, Billy H
Singla, Nirmish
Singla, Ajay K
author_sort Cordon, Billy H
collection PubMed
description The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.
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spelling pubmed-49381392016-07-21 Artificial urinary sphincters for male stress urinary incontinence: current perspectives Cordon, Billy H Singla, Nirmish Singla, Ajay K Med Devices (Auckl) Review The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point. Dove Medical Press 2016-07-04 /pmc/articles/PMC4938139/ /pubmed/27445509 http://dx.doi.org/10.2147/MDER.S93637 Text en © 2016 Cordon et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Review
Cordon, Billy H
Singla, Nirmish
Singla, Ajay K
Artificial urinary sphincters for male stress urinary incontinence: current perspectives
title Artificial urinary sphincters for male stress urinary incontinence: current perspectives
title_full Artificial urinary sphincters for male stress urinary incontinence: current perspectives
title_fullStr Artificial urinary sphincters for male stress urinary incontinence: current perspectives
title_full_unstemmed Artificial urinary sphincters for male stress urinary incontinence: current perspectives
title_short Artificial urinary sphincters for male stress urinary incontinence: current perspectives
title_sort artificial urinary sphincters for male stress urinary incontinence: current perspectives
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938139/
https://www.ncbi.nlm.nih.gov/pubmed/27445509
http://dx.doi.org/10.2147/MDER.S93637
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