Advertisement

Does nocturnal deactivation of the artificial urinary sphincter lessen the risk of urethral atrophy?

      Abstract

      Objectives. To compare nocturnal deactivation with nocturnal activation of the artificial urinary sphincter (AUS) to determine whether nocturnal deactivation reduces the risk of urethral atrophy and subsequent recurrent incontinence. To the best of our knowledge, no review comparing these two approaches has been performed.
      Methods. At the Mayo Clinic, all patients are instructed to deactivate their AUS at night; at Baylor, all patients keep their AUS activated all the time. At each institution, a group of consecutive men with comparable severe urinary incontinence after radical retropubic prostatectomy were selected; 61 and 46 patients from the Mayo Clinic and Baylor, respectively, were available for review. All Mayo Clinic patients strictly adhered to nocturnal deactivation of their AUS and all 46 patients from Baylor kept their AUS activated at all times, except during voiding. Each patient was reviewed for the long-term risk of subsequent reoperation, especially regarding recurrent incontinence due to urethral atrophy.
      Results. Seventeen (27.8%) of the 61 patients from Mayo (mean follow-up 40 months) required a repeated operation. Of the 17 AUS failures, 6 (35%) were due to urethral atrophy. Of the 46 patients from Baylor (mean follow-up 28 months), 16 (34.7%) required a repeated operation. Of the 16 AUS failures, 10 (62%) were due to urethral atrophy. Overall, the patients who nocturnally deactivated their AUS had a 10% risk of atrophy-related incontinence compared with a 21% risk in the nocturnally activated group.
      Conclusions. Although not statistically significant, nocturnal deactivation appears to decrease the risk of urethral atrophy and recurrent incontinence (10% versus 21%). Nocturnal deactivation should be considered in men who are dry at night and have sufficient motivation to lessen the risk of urethral atrophy secondary to cuff compression.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Litwiller S.E.
        • Kim K.B.
        • Fone P.D.
        • et al.
        Post-prostatectomy incontinence and the artificial urinary sphincter.
        J Urol. 1996; 156: 1975-1980
        • Leo M.E.
        • Barrett D.M.
        Success of the narrow-backed cuff design of the AMS800 artificial urinary sphincter.
        J Urol. 1993; 150: 1412-1414
        • Gundian J.C.
        • Barrett D.M.
        • Parulkar B.G.
        Mayo Clinic experience with use of the AMS800 artificial urinary sphincter for urinary incontinence following radical prostatectomy.
        J Urol. 1989; 142: 1459-1461
        • Marks J.L.
        • Light J.K.
        Management of urinary incontinence after prostatectomy with the artificial urinary sphincter.
        J Urol. 1989; 142: 302-304
        • Elliott D.S.
        • Barrett D.M.
        Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter.
        J Urol. 1998; 159: 1206-1208
        • Fishman I.J.
        • Ridwan S.
        • Scott F.B.
        Experience with the artificial urinary sphincter model AS800 in 148 patients.
        J Urol. 1989; 141: 307-310
        • Haab F.
        • Trockman B.A.
        • Zimmern P.E.
        • et al.
        Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3.
        J Urol. 1997; 158: 435-439