Artificial urinary sphincter for post‐prostatectomy incontinence

Objective  To assess the role of the artificial urinary sphincter in the management of patients with post‐prostatectomy incontinence. Patients and methods The study comprised 28 patients (mean age 71 years, range 45–81) with post‐prostatectomy incontinence caused by sphincter deficiency who underwent implantation of an artificial sphincter and were followed for a mean of 41 months (range 6–79). Results  Twenty‐one (75%) patients had a bulbar cuff and seven (25%) had a membranous urethral cuff implanted. Problems with the bulbar urethral cuff included persistent stress leakage in six, system failure in two and infection in one patient. Nine patients with the bulbar urethral cuff and one patient with the membranous urethral cuff required revision. Of the nine re‐operations in those fitted with a bulbar urethral cuff, five required a higher pressure balloon, one a smaller cuff, two had system failures replaced and one had a membranous urethral cuff implanted because of infection. Three of these nine patients needed a third operation and in all of these a membranous urethral cuff was inserted. A total of 33 operations were performed in 21 patients with bulbar urethral cuffs (a re‐operation rate of 57%) and eight operations were carried out in seven patients with membranous urethral cuffs (a re‐operation rate of 14%). Three patients needed anticholinergic therapy and one needed a clam cystoplasty for intractable instability. Twenty‐four patients (86%) are dry and fully continent, three (11%) have occasional stress leakage and one patient had a cerebro‐vascular accident9 months after surgery and now has an indwelling catheter. Conclusions  Patients who had artificial sphincters implanted to treat post‐prostatectomy incontinence achieved a social continence rate of 96%. With bulbar urethral sphincters there was a high incidence of post‐implantation incontinence and a high re‐operation rate to achieve this success.