Elsevier

Urology

Volume 71, Issue 1, January 2008, Pages 90-93
Urology

Reconstructive urology
Long-term Follow-up of Single Versus Double Cuff Artificial Urinary Sphincter Insertion for the Treatment of Severe Postprostatectomy Stress Urinary Incontinence

https://doi.org/10.1016/j.urology.2007.08.017Get rights and content

Objectives

To assess the long-term effectiveness and complications associated with single and double cuff artificial urinary sphincter (AUS) implantation for the treatment of severe postprostatectomy stress urinary incontinence (SUI).

Methods

We updated the outcomes of 56 men with postprostatectomy SUI who underwent single (28 patients) or double (28 patients) cuff AUS placement. Originally patients in each cohort were matched according to preoperative pad usage, risk factors for complications, and age. Continence, quality of life, and complications were assessed according to the Incontinence Impact Questionnaire Short Form (IIQ-7), postoperative pad usage, chart review, and patient/family interview.

Results

Updated data were available for 47 men (25 single cuff and 22 double cuff patients). Mean pre-AUS implant age was 67 years for each group. Average follow-up was 74.1 months and 58.0 months for single and double cuff patients, respectively. No statistically significant difference in continence improvement was noted between the two groups according to daily pad usage and overall dry rate. IIQ-7 scores improved from 14.8 to 4.1 after single cuff implants and from 16.3 to 6.4 after double cuff placement (P = 0.34). Men receiving a single cuff AUS reported seven complications requiring further operative intervention. Double cuff patients underwent 12 additional surgeries secondary to complications.

Conclusions

Despite our earlier findings, no significant difference in dry rate, overall continence, or quality of life was seen with long-term follow-up of single versus double cuff AUS patients. Furthermore, men receiving double cuff implants may be at higher risk of complications requiring additional surgery.

Section snippets

Material and Methods

Originally a retrospective review of 56 men who underwent AUS (AMS 800; American Medical Systems, Minnetonka, Minn) placement by one surgeon (G.T.B.) to correct severe postprostatectomy SUI (more than 5 pads per day) was performed. Twenty-eight single cuff and 28 double cuff implant patients composed the study population. Patients from each cohort were matched with regard to degree of incontinence (as reflected by daily pad usage), comorbidities (diabetes mellitus, prior pelvic radiation

Results

Updated data were available for 47 men (25 single cuff and 22 double cuff patients). Mean pre-AUS implant age was 67.2 for men receiving single cuff AUS and 67.9 years for the double cuff cohort. Average follow-up was 74.1 months and 58.0 months for single and double cuff patients, respectively (P <0.001). Continence results for both groups are listed in Table 1. Mean IIQ-7 scores improved from 14.8 to 4.1 after single cuff implantation and from 16.3 to 6.4 after double cuff placement (P =

Comment

Severe SUI may occur in up to 5% of patients after prostatectomy.9 Viable treatment options include placement of an artificial sphincter, male sling, external collection device, or catheter drainage. Our earlier findings concluded that, when compared with single cuff implants, double cuff AUS provided improved dry rates with comparable complication rates when used in patients with severe postprostatectomy SUI.3 However, in our original study the mean follow-up of the double cuff group was less

Conclusions

Despite our earlier findings, no statistically significant difference in overall continence, dry rate, or quality of life was seen with long-term follow-up of single versus double cuff AUS patients. Furthermore, men receiving double cuff implants may be at higher risk of complications requiring additional surgery. On the basis of these findings we do not routinely recommend the placement of a tandem cuff for the treatment of severe postprostatectomy SUI. Potential risks and benefits of single

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