Artificial urinary sphincter revision for urethral atrophy: Comparing single cuff downsizing and tandem cuff placement

Vol. 43 (2): 264-270, March – April, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0240


ORIGINAL ARTICLE

Brian J. Linder 1, Boyd R. Viers 1, Matthew J. Ziegelmann 1, Marcelino E. Rivera 1, Daniel S. Elliott 1

1 Department of Urology, Mayo Clinic, Rochester, MN, USA

ABSTRACT

Objective: To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS) revision for urethral atrophy.

Materials and Methods: We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for ure­thral atrophy. Multiple clinical and surgical variables were evaluated for potential as­sociation with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs).

Results: Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82%) were tandem cuff placements, 12 (18%) were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98), body-mass index (p=0.95), prior pelvic radiation exposure (p=0.73) and length of follow-up (p=0.12). Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94). Likewise, no signifi­cant difference was identified for tandem cuff placement (ref. single cuff) when evalu­ating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94) or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77).

Conclusions: There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy.

Keywords:  Urinary Sphincter, Artificial; Urinary Incontinence; Male

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