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.
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Article info
Publication history
Accepted:
January 24,
2001
Received in revised form:
January 24,
2001
Received:
September 11,
2000
Identification
Copyright
© 2001 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
