89 Twenty years of artificial urinary sphincters in the treatment of female urinary incontinence.

Aim:  To review the use of the artificial urinary sphincter (AUS) in female urinary incontinence. Methods:  Review of a single surgeon experience with use of the AMS 800 (American Medical Systems) in the period Aug 1983–July 2005. Data was collected prospectively on all patients. Follow‐up information was complete on all cases to Oct 2005. Results:  A total of 48 patients had an AUS with an average follow‐up of 12.5 years (0.3–22 years). Indications for placement were urethral incompetence following failed previous anti‐stress surgery (36), pelvic trauma (seven), previous urethral surgery (two), myelomeningocele (one) and other (two). A total of 19 revision procedures were required in 15 patients (31%). With the exception of one case with infection, revisions related to mechanical failure. Fluid loss occurred in 16 cases with either splits or small holes in the tubing being the most commonly identified cause. Non‐leak device malfunction occurred in only two patients (5%). Summary:  The AUS is a highly successful intervention for incontinence related to intrinsic sphincter deficiency in female patients. It avoids the potential problem of bladder outflow obstruction associated with slings. Up to a third of patients will require revision surgery with long term follow‐up. However this is largely related to fluid leakage and readily addressed. The AUS may be an underutilised treatment modality for female urinary incontinence and should be considered in selected patients with intrinsic sphincter deficiency in preference to other procedures.