Female Urinary Incontinence and Artificial Urinary Sphincter: Study of Efficacy and Risk Factors for Failure and Complications

BackgroundThe artificial urinary sphincter (AUS) has become a commonly used therapy for severe urinary incontinence (UI) due to intrinsic sphincter deficiency (ISD).ObjectiveTo evaluate retrospectively the efficacy and risk factors for failure and complications of AUS implantation in women with nonneurologic UI.Design, setting, and participantsFrom May 1987 to December 2009, 215 women with ISD were treated by AUS implantation, with a mean age of 62.8 yr and a mean follow-up of 6 yr (standard deviation: 5.6 yr). Previous surgical procedures to treat incontinence had been performed in 88.8% of the patients. Urodynamic assessment was required. Patients using only 0 or 1 pad at the end of follow-up were considered continent. The patient's level of satisfaction was evaluated by a global analogue scale and clinical interview.InterventionAll women had AUS implantation.MeasurementsPatients were evaluated for continence rate, risk factors for failures, and complications.Results and limitationsAt the end of follow-up, 158 patients (73.5%) were continent, and 170 (79%) were satisfied. The redo rate was 15.3% after a mean interval of 8.47 yr for the first redo procedure. Fifteen explantations (7%) were performed. The only risk factor for intraoperative complications (10.7%) was smoking (p < 0.004). Six patients (2.8%) were lost to follow-up. AUS failed to treat incontinence in 51 patients (23.7%) due to defective manipulation in 27.4% of the cases. On multivariate analysis, risk factors for failure were age >70 yr (odds ratio [OR]: 2.46), a history of the Burch procedure (OR: 2.28), or pelvic radiotherapy (OR: 4.37) (p < 0.05).ConclusionsThe place for this safe and long-lasting effective technique in the treatment of UI due to recurrent sphincter deficiency is confirmed. Screening for these risk factors should allow better patient selection.