Clinical outcome of artificial urinary sphincter implantation to treat complex urinary incontinence

Objective To present the experience of artificial urinary sphincter implantation as a part of urinary tract reconstruction for patients with refractory urinary incontinence. Methods Between April 2002 and April 2016, a total of 30 patients (median age, 40.2 years, 29 males, 1 female ) with urinary incontinence had accepted artificial urinary sphincter placement during urinary tract reconstruction. Assessments included case selection, perioperative management, urinary continence, artificial urinary sphincter status, complications, quality of life and additional procedures. Results The mean follow-up time was 52.8 months ranged from 25 months to 13 years. At the latest visit, 23 patients (76.7%) maintained the primary artificial urinary sphincter. Four patients (13.3%) had artificial urinary sphincter revisions. Explantations were performed in three patients. Twenty-two patients were socially continent, of which 14 patients were totally dry, leading to the overall success rate as 73.3%. There was a significant reduction in pad count from 3.8±0.3 to 1.1±0.3 diapers per day (P<0.001). There was a significant reduction on the impact of urinary incontinence on quality of life, with a decrease from 6.9 ± 0.3 to 1.9 ± 0.5 (P<0.001) on a visual analogue scale (VAS). The complication rate was 26.7%; including infections (n=4), erosions (n=3), and mechanical failure (n=1). Conclusions Artificial urinary sphincter implantation is an effective treatment as a key procedure for urinary tract reconstruction, especially in complicated urinary incontinence cases. Other than post-prostatectomy incontinence cases, the quality and choice of management modalities should be tailored to the unique needs of each individual with caution. Key words: Artificial urinary sphincter; Urinary incontinence; Urinary tract reconstruction; Complication; Follow up