Although the artificial urinary sphincter (AUS) is widely regarded as the “gold standard” for surgical correction of male stress urinary incontinence, long-term durability for symptom control is variable. A significant number of men will experience a decline in device-related improvement over time. With erosion of initial success, men sufficiently bothered by recurrent incontinence not caused by device malfunction may seek surgical revision. Secondary surgery requires careful consideration on the part of the prosthetic urologist and a keen awareness of sound surgical techniques. The armamentarium for revision has traditionally consisted of strategies involving cuff downsizing and/or relocation, modification of the pressure regulating balloon, urethral wrapping, addition of a tandem cuff, or use of transcorporal cuff placement. These options will be presented in view of their evidence and theoretical advantages and disadvantages. In addition, we will discuss a newer approach of growing popularity that serves to challenge existing dogma and shift the paradigm of AUS revision surgery.
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Linder BJ, Rivera ME, Ziegelmann MJ, Elliott DS. Long-term outcomes following artificial urinary sphincter placement: An analysis of 1082 cases at Mayo Clinic. Urology. 2015;86:602–7.
Fuller TW, Ballon-Landa EE, Gallo K, Smith TG 3rd, Ajay D, Westney OL, et al. Outcomes and risk factors of revision and replacement artificial urinary sphincter implantation in radiated and non-radiated patients. J Urol. 2020. Epub ahead of print.
Loh-Doyle JC, Hartman N, Nazemi A, Wayne K, Doumanian LR, Ginsberg DA, et al. Mechanical failure rates of artificial urinary sphincter components: Is the 3.5-cm urethral cuff at higher risk? Neurourol Urodyn. 2019;38:187–92.
Chouhan JD, Terlecki RP. A user’s guide for surgery involving the artificial urinary sphincter. Sex Med Rev. 2019;7:167–77.
Bugeja S, Ivaz SL, Frost A, Andrich DE, Mundy AR. Urethral atrophy after implantation of an artificial urinary sphincter: Fact or fiction? BJU Int. 2016;117:669–76.
Moses RA, Keihani S, Craig JR, Basilius J, Hotaling JM, Lenherr SM, et al. Efficacy of pressure regulating balloon exchange in men with post artificial urinary sphincter persistent or recurrent stress urinary incontinence. Urology. 2019;123:252–7.
Trost L, Elliott D. Small intestinal submucosa urethral wrap at the time of artificial urinary sphincter placement as a salvage treatment option for patients with persistent/recurrent in- continence following multiple prior sphincter failures and erosions. Urology. 2012;79:933–8.
Maurer V, Marks P, Dahlem R, Rosenbaum CM, Meyer CP, Riechardt S, et al. Functional outcomes of artificial urinary sphincter implantation with distal bulbar double cuff in men with and without a history of external beam radiotherapy: an analysis of a prospective database. BJU Int. 2019;124:1040–6.
O’Connor RC, Lyon MB, Guralnick ML, Bales GT. Long-term follow- up of single versus double cuff artificial urinary sphincter insertion for the treatment of severe postprostatectomy stress urinary incontinence. Urology. 2008;71:90–3.
Manka MG, Wright EJ. Does use of a second cuff improve artificial urinary sphincter effectiveness? Evaluation using a comparative cadaver model. J Urol. 2015;194:1688–91.
O’Connor RC, Gerber GS, Avila D, Chen AA, Bales GT. Comparison of outcomes after single or DOUBLE-CUFF artificial urinary sphincter insertion. Urology. 2003;62:723–6.
Guralnick ML, Miller E, Toh KL, Webster GD. Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol. 2002;167:2075–9.
Brant WO, Erickson BA, Elliott SP, Powell C, Alsikafi N, McClung C, et al. Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology. 2014;84:934–9.
Pearlman AM, Rasper AM, Terlecki RP. Proof of concept: exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon. Investig Clin Urol. 2018;59:275–9.
Pearlman AM, Terlecki RP. Subcuff capsulotomy and pressure regulating balloon interrogation: dispelling urethral atrophy during urinary sphincter revision for recurrent incontinence. VJPU. 2018;2:134.
Henry G, Wilson S, Delk J, Carson C, Wiygul J, Tornehl, Cleves M, Silverstein A, Donatucci C. Revision washout decreases penile prosthesis infection in revision surgery: multicenter study. J Urol. 2005;173:89.
Conflict of interest
SKW: Consultant; AMT, Coloplast, International Medical Devices. Lecturer; Boston Scientific. Stockholder; NeoTract. RPT: Consultant; Boston Scientific. Lecturer; Boston Scientific. Grant Support; Boston Scientific, Department of Defense.
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Terlecki, R.P., Wilson, S.K. A new paradigm for surgical revision of the artificial urinary sphincter for recurrent stress urinary incontinence: Wilson’s Workshop 11. Int J Impot Res 34, 37–43 (2022). https://doi.org/10.1038/s41443-020-0307-8
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