Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival

Arnav Srivastava, Gregory A. Joice, Hiten D. Patel, Madeleine G. Manka, Nikolai A. Sopko, Edward James Wright

Research output: Contribution to journalArticle

Abstract

Background: Up to 50% of patients receiving an artificial urinary sphincter (AUS) require surgical revision after initial placement. However, the literature is heterogeneous regarding the leading causes of AUS failure and appropriate surgical management. Objective: To inform a revision approach by tabulating the causes of AUS failure, assessing AUS component survival, and examining the single-component revision efficacy. Design, setting, and participants: We retrospectively reviewed 168 patients receiving AUS placements carried out by a single surgeon from 2008 to 2016 at a high-volume academic institution. The median follow-up from initial placement was 2.7 yr, with 37.5% experiencing recurrent incontinence. The cuff size ranged from 4.0 to 5.5. cm, with median size of 4.5. cm. Intervention: Patients without infection or erosion underwent systematic device interrogation and revision, starting with the pressure-regulating balloon (PRB) and then, if necessary, the urethral cuff. Device revision involved either PRB-only correction or cuff and PRB revision. Outcome measurements and statistical analysis: We used bootstrapped intervals to estimate the mean time to failure for individual AUS components. Kaplan-Meier estimates were used to compare survival for individual components and for revised devices by revision technique. Results and limitations: PRB malfunction most commonly caused device failure, while cuff or pump malfunction was rare. Among patients undergoing surgical revision, those with PRB-only correction had similar outcomes to those with more extensive device correction (cuff and PRB exchange; p = 0.46). This study, while systematic and detailed, is limited by sample size, follow-up length, and its retrospective nature. Conclusions: PRB malfunction most commonly caused AUS failure in our cohort. PRB-only correction may satisfactorily restore AUS function in select patients. Consequently, initial interrogation of the PRB may avoid a second incision and urethral exposure for many patients requiring AUS revision. Patient summary: Artificial urinary sphincters remain prone to failure over time. In many instances, correcting only the pressure-regulating balloon may effectively restore device function, allowing for a less invasive revision. Pressure-regulating balloon (PRB) malfunction is a common cause of artificial urinary sphincter failure, but failure due to pump or occlusive cuff malfunction is rare. Thus, a large set of patients may undergo PRB-only revision to restore device function without urethral exposure.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Artificial Urinary Sphincter
Reoperation
Pressure
Equipment and Supplies
Survival
Equipment Failure
Kaplan-Meier Estimate
Sample Size

Keywords

  • Artificial urinary sphincter
  • Device revision
  • Device survival
  • Stress urinary incontinence

ASJC Scopus subject areas

  • Urology

Cite this

Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision : Implications of Device Component Survival. / Srivastava, Arnav; Joice, Gregory A.; Patel, Hiten D.; Manka, Madeleine G.; Sopko, Nikolai A.; Wright, Edward James.

In: European Urology Focus, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival",
abstract = "Background: Up to 50{\%} of patients receiving an artificial urinary sphincter (AUS) require surgical revision after initial placement. However, the literature is heterogeneous regarding the leading causes of AUS failure and appropriate surgical management. Objective: To inform a revision approach by tabulating the causes of AUS failure, assessing AUS component survival, and examining the single-component revision efficacy. Design, setting, and participants: We retrospectively reviewed 168 patients receiving AUS placements carried out by a single surgeon from 2008 to 2016 at a high-volume academic institution. The median follow-up from initial placement was 2.7 yr, with 37.5{\%} experiencing recurrent incontinence. The cuff size ranged from 4.0 to 5.5. cm, with median size of 4.5. cm. Intervention: Patients without infection or erosion underwent systematic device interrogation and revision, starting with the pressure-regulating balloon (PRB) and then, if necessary, the urethral cuff. Device revision involved either PRB-only correction or cuff and PRB revision. Outcome measurements and statistical analysis: We used bootstrapped intervals to estimate the mean time to failure for individual AUS components. Kaplan-Meier estimates were used to compare survival for individual components and for revised devices by revision technique. Results and limitations: PRB malfunction most commonly caused device failure, while cuff or pump malfunction was rare. Among patients undergoing surgical revision, those with PRB-only correction had similar outcomes to those with more extensive device correction (cuff and PRB exchange; p = 0.46). This study, while systematic and detailed, is limited by sample size, follow-up length, and its retrospective nature. Conclusions: PRB malfunction most commonly caused AUS failure in our cohort. PRB-only correction may satisfactorily restore AUS function in select patients. Consequently, initial interrogation of the PRB may avoid a second incision and urethral exposure for many patients requiring AUS revision. Patient summary: Artificial urinary sphincters remain prone to failure over time. In many instances, correcting only the pressure-regulating balloon may effectively restore device function, allowing for a less invasive revision. Pressure-regulating balloon (PRB) malfunction is a common cause of artificial urinary sphincter failure, but failure due to pump or occlusive cuff malfunction is rare. Thus, a large set of patients may undergo PRB-only revision to restore device function without urethral exposure.",
keywords = "Artificial urinary sphincter, Device revision, Device survival, Stress urinary incontinence",
author = "Arnav Srivastava and Joice, {Gregory A.} and Patel, {Hiten D.} and Manka, {Madeleine G.} and Sopko, {Nikolai A.} and Wright, {Edward James}",
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T2 - Implications of Device Component Survival

AU - Srivastava, Arnav

AU - Joice, Gregory A.

AU - Patel, Hiten D.

AU - Manka, Madeleine G.

AU - Sopko, Nikolai A.

AU - Wright, Edward James

PY - 2018/1/1

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N2 - Background: Up to 50% of patients receiving an artificial urinary sphincter (AUS) require surgical revision after initial placement. However, the literature is heterogeneous regarding the leading causes of AUS failure and appropriate surgical management. Objective: To inform a revision approach by tabulating the causes of AUS failure, assessing AUS component survival, and examining the single-component revision efficacy. Design, setting, and participants: We retrospectively reviewed 168 patients receiving AUS placements carried out by a single surgeon from 2008 to 2016 at a high-volume academic institution. The median follow-up from initial placement was 2.7 yr, with 37.5% experiencing recurrent incontinence. The cuff size ranged from 4.0 to 5.5. cm, with median size of 4.5. cm. Intervention: Patients without infection or erosion underwent systematic device interrogation and revision, starting with the pressure-regulating balloon (PRB) and then, if necessary, the urethral cuff. Device revision involved either PRB-only correction or cuff and PRB revision. Outcome measurements and statistical analysis: We used bootstrapped intervals to estimate the mean time to failure for individual AUS components. Kaplan-Meier estimates were used to compare survival for individual components and for revised devices by revision technique. Results and limitations: PRB malfunction most commonly caused device failure, while cuff or pump malfunction was rare. Among patients undergoing surgical revision, those with PRB-only correction had similar outcomes to those with more extensive device correction (cuff and PRB exchange; p = 0.46). This study, while systematic and detailed, is limited by sample size, follow-up length, and its retrospective nature. Conclusions: PRB malfunction most commonly caused AUS failure in our cohort. PRB-only correction may satisfactorily restore AUS function in select patients. Consequently, initial interrogation of the PRB may avoid a second incision and urethral exposure for many patients requiring AUS revision. Patient summary: Artificial urinary sphincters remain prone to failure over time. In many instances, correcting only the pressure-regulating balloon may effectively restore device function, allowing for a less invasive revision. Pressure-regulating balloon (PRB) malfunction is a common cause of artificial urinary sphincter failure, but failure due to pump or occlusive cuff malfunction is rare. Thus, a large set of patients may undergo PRB-only revision to restore device function without urethral exposure.

AB - Background: Up to 50% of patients receiving an artificial urinary sphincter (AUS) require surgical revision after initial placement. However, the literature is heterogeneous regarding the leading causes of AUS failure and appropriate surgical management. Objective: To inform a revision approach by tabulating the causes of AUS failure, assessing AUS component survival, and examining the single-component revision efficacy. Design, setting, and participants: We retrospectively reviewed 168 patients receiving AUS placements carried out by a single surgeon from 2008 to 2016 at a high-volume academic institution. The median follow-up from initial placement was 2.7 yr, with 37.5% experiencing recurrent incontinence. The cuff size ranged from 4.0 to 5.5. cm, with median size of 4.5. cm. Intervention: Patients without infection or erosion underwent systematic device interrogation and revision, starting with the pressure-regulating balloon (PRB) and then, if necessary, the urethral cuff. Device revision involved either PRB-only correction or cuff and PRB revision. Outcome measurements and statistical analysis: We used bootstrapped intervals to estimate the mean time to failure for individual AUS components. Kaplan-Meier estimates were used to compare survival for individual components and for revised devices by revision technique. Results and limitations: PRB malfunction most commonly caused device failure, while cuff or pump malfunction was rare. Among patients undergoing surgical revision, those with PRB-only correction had similar outcomes to those with more extensive device correction (cuff and PRB exchange; p = 0.46). This study, while systematic and detailed, is limited by sample size, follow-up length, and its retrospective nature. Conclusions: PRB malfunction most commonly caused AUS failure in our cohort. PRB-only correction may satisfactorily restore AUS function in select patients. Consequently, initial interrogation of the PRB may avoid a second incision and urethral exposure for many patients requiring AUS revision. Patient summary: Artificial urinary sphincters remain prone to failure over time. In many instances, correcting only the pressure-regulating balloon may effectively restore device function, allowing for a less invasive revision. Pressure-regulating balloon (PRB) malfunction is a common cause of artificial urinary sphincter failure, but failure due to pump or occlusive cuff malfunction is rare. Thus, a large set of patients may undergo PRB-only revision to restore device function without urethral exposure.

KW - Artificial urinary sphincter

KW - Device revision

KW - Device survival

KW - Stress urinary incontinence

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