Artificial Urinary Sphincter for Treatment of Stress Urinary Incontinence in Women
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
The artificial urinary sphincter (AUS) remains an alternative to slings or periurethral injection therapy in the management of urinary incontinence, especially when the aforementioned interventions have failed. The aus has been most often used for treatment of incontinence due to primary urethral sphincter deficiency (type iii stress urinary incontinence [SUI], or intrinsic sphincter deficiency [ISD] [1–3]). Isd may be the result of periurethral fibrosis from prior anti-incontinence procedures, neurological disorders (spinal cord injury, peripheral neuropathy), radical pelvic operations, pelvic radiation therapy, or the effects of aging and estrogen deficiency on the urethra and anterior vaginal wall. These conditions affect the ability of the urethra wall elements to coapt, thereby producing a poorly functional sphincteric mechanism. The pubovaginal sling is considered the gold standard for the treatment of isd, yet some patients will have less than adequate results despite several attempts [4]. The aus enhances higher intraurethral pressures by increasing pressure circumferentially around the urethra, lessening the transmission of intra-abdominal pressures. Therefore, in some cases, the aus may benefit women with urethral weakness and good anterior vaginal wall who have sphincteric dysfunction.
Tissue engineering and cell therapies for neurogenic bladder augmentation and urinary continence restoration
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Urinary incontinence due to intrinsic urethral sphincter insufficiency develops in many central or peripheral neurological disorders affecting the nerves that supply the urethral rhabdosphincter. In patients with severe incontinence, the treatment of reference remains the implantation of an artificial urinary sphincter.31–35 Alternatively, a compressive device36–39 can be implanted or a bulking agent injected.40 Biologic or synthetic bulking agents investigated over the last decades include collagen, polytetrafluoroethylene paste (Teflon), silicone microparticules, carbon beads, polyacrylamide hydrogel, adipocytes, and chondrocytes.31,37,41,42 These agents may increase resistance to urine flow, augment urethral mucosa, and improve coaptation and intrinsic sphincter function. However, overall results have been disappointing,40 because of particle migration or rapid resorption.
Complications of Female Incontinence Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Sphincteric incompetence in women is most commonly treated with suburethral sling surgery or with periurethral bulking agents. The familiarity, safety, and efficacy of these procedures have relegated artificial urinary sphincter (AUS) surgery as a “procedure of last resort.” However, AUS placement surgery can be performed via a transvaginal (106,107) or transabdominal approach (108,109), and in the properly selected patients has been associated with excellent outcome. Appell (106) and Hadley (107) report >90% success without revision in >90% of patients status post-transvaginal AUS placement.
Management of stress urinary incontinence in spinal cord injured female patients with a mid-urethral tape – a single center experience
Published in The Journal of Spinal Cord Medicine, 2018
Vasileios I. Sakalis, Michael S. Floyd, Philippa Caygill, Chloe Price, Ben Hartwell, Peter J. Guy, Melissa C. Davies
Nine patients (23.7%) develop tape related complications. There were five de novo urgency episodes, three after TVT and two after TOT. It is unclear whether this was due to a stimulation of proximal urethral afferent receptors or if it was due to a change in bladder behavior as a result of SCI. All were noted to have had flat traces in their pre-operative VUDS and documented detrusor overactivity postoperatively. There was a single case of vaginal extrusion following TOT necessitating tape removal at 4 months. Another patient had frequent dysreflexia episodes postoperatively and part of the tape was excised. One patient reported worsening of incontinence and increasing leakage from her SPC site. These three patients subsequently underwent clam ileocystoplasty and insertion of an artificial urinary sphincter with the cuff placed around the bladder neck.
Gonococcal epididymo-orchitis in an octogenarian
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
This case is of an eighty-one-year-old Caucasian gentleman with a prior medical history of recurrent urinary tract infections, prostate cancer followed by prostatectomy, and urinary incontinence for which he underwent permanent placement of an artificial urinary sphincter (AUS). He presented to the emergency department with right-sided perineal pain, radiating towards his lower back, along with rigors and chills, for five days. He denied dysuria, urinary urgency, urethral discharge, scrotal erythema or swelling. He was sexually active, however denied a history of previous sexually transmitted infections. Review of his social history elicited high risk sexual behavior with five sexual partners in the preceding year.
The AdVance™ male sling: does it stand the test of time?
Published in Scandinavian Journal of Urology, 2021
Ishtiakul G. Rizvi, Pravisha Ravindra, Michelle Pipe, Ridwaan Sohawon, Thomas King, Mohammed Belal
Radical prostatectomy (RP) represents the most common cause of stress urinary incontinence (SUI) in men [1]. Current rates are cited as 21.3% after robotic RP and 20.2% after open RP at 12 months with the definition used being patients requiring at least one pad change in 24 h [2]. Other causes of SUI in men include radical cystectomy with neo-bladder, transurethral resection of prostate as well as laser enucleation of prostate. There are a number of commercially available devices to surgically treat the condition. The artificial urinary sphincter (AUS) is considered the gold standard, achieving continence rates of 82–92% (0–1 pad/24 h) but there is a growing number of male sling devices on the market [3].
Related Knowledge Centers
- Bladder
- Urinary Incontinence
- Urinary Retention
- Scrotum
- Urethra
- Implant
- Urethral Sphincters
- Retropubic Space
- Saline
- Retroperitoneal Space