Objective: To assess the long-term outcome of patients who had an artificial urinary sphincter (AUS) implanted between 10 and 15 years ago.
Patients and methods: Of 68 patients who had an AUS implanted more than 10 years ago, 61 were followed with sufficient detail for analysis. Thirty-four had a neuropathic bladder with sphincter dysfunction, 15 had post-prostatectomy sphincter weakness incontinence and 12 further patients had a variety of indications.
Results: The 61 patients experienced a total of 58 major complications and 49 have required at least one revision procedure. Currently eight (13%) patients are satisfactorily continent with their original AUS in situ and 29 others have a satisfactory revised AUS. Thus 37 of 61 (61%) are continent using an AUS at least 10 years after first implantation. Eleven patients died and of these two had a satisfactory original AUS in situ and seven had successful revisions. In two patients the AUS failed but they were considered unfit for revision. Four female patients were continent and used intermittent catheterization after the explantation of eroded AUS cuffs. In seven patients the AUS was abandoned; two of these patients reverted to condom drainage and five had continent or incontinent urinary diversions fashioned. Thus, if those who died with a functioning AUS are included, 46 of 61 (75%) achieved long-term continence with the AUS.
Conclusions: Despite the high complication and revision rate, these results show that acceptable continence rates can be achieved in the long-term, particularly in the male neuropathic bladder and in those with post-prostatectomy sphincter weakness. Many of the complications encountered may be less common with the current re-designed models of the AUS. However, it is essential that both surgeon and patient recognize and accept the likelihood of complications and revisions before using the AUS. The continued use of the AUS where simpler methods of obtaining continence are inappropriate remains justified.