Hypothesis / aims of study
Men undergoing radical prostatectomy for prostate cancer frequently report the troublesome symptom of stress urinary incontinence (SUI). Prevalence estimates vary widely between 5% and 57% depending on definition, timing of assessment after surgery, and population characteristics. The rate of recovery of continence plateaus at around 12 months after surgery. The artificial urinary spincter (AUS) AMS 800 (American Medical Systems, Minnetonka, MN) has been proven and achieved the gold standard status for the treatment of stress urinary incontinence in men with regard to the long term follow up outcomes [1].
However, some patients report about urine leakage during higher intraabdominal pressure after AUS-placement. To improve the continent results of these patients, we placed in additional to the occluding cuff (OC) and the pressure regulating balloon, in a second procedure a stress-relief cuff (SRC) in lower abdomen to provide additional pressure to the OC. As the stress-relief cuff we used a standard cuff from (AMS800™, AmericanMedicalSystems, Minnetonka , MN, USA). To the best of our knowledge, we are the first referral center for male SUI, who investigated placing a stress-relief cuff after AUS.
Study design, materials and methods
In total 211 AUS were placed in the time between 1/2008 and 12/2017. SRC was indicated in 9 (4,3%) patients with persistence involuntary leakage of urine that occurs when intraabdominal pressure rises. We used a telephone questionnaire to collect postoperative data as daily pad use and satisfaction rate. Average age at time of the SRC-placement was 70.7 ( 9.6) years. The device was placed at an average time of 18.2 months (M = 18.5) after the AUS-implantation and the mean follow-up time was 21 (M= 6) months (range 2 to 80 months).
Interpretation of results
Our objective findings can be explained as follows: a) in almost 1/4 of patients we did not observe any significant improvement, because of the selection bias and the fact that patients with neurogenic voiding disorders and not ideal candidates; b) secondly patient's after multiple abdominal surgeries are probably not able to obtain a sufficient intraabdominal pressure. And consequently do not influence the pressure inside the stress cuff.