Results

In an editorial comparing results of AUS implantation to collagen injection for the treatment of post-prostatectomy urinary incontinence, there were five reports of AUS implantation case series with a total of 286 patients. These case series had mean follow-ups of 18, 23, 37, 41, and 44 months. Using a commonly accepted definition of success as the use of one pad or less per day, 216 (75%) of the patients achieved success (Figure 2).  In this series, 62% had no revision surgeries (Figure 3).4

In a later report of a single case series with longer follow-up, 113 men who had undergone AUS implantation for post-prostatectomy incontinence had a mean follow-up of  73 months (range 20-170 months).5 Using the same definition of success, 65% of patients remained dry (one pad or less per day (Figure 4). Fourteen (12%) of these patients had undergone surgical revision. Seventy-two percent of these patients were either very satisfied or satisfied (Figure 5).

Male slings

The artificial urinary sphincter was developed in 19736 in part because of the failure of other surgical procedures including male slings to effectively treat post-prostatectomy incontinence. Most male slings compress the bulbous uretha and have short comings.7 While a newer repositioning type of male sling may be more attractive, 8 early results with with this and previous slings are not as favorable as early results with artificial urinary sphincter implantation which remains the gold standard.


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Conclusions

Urinary incontinence following RP is a moderate or big problem in at least 8% of men. This has a significant impact of quality of life. Fortunately, for men suffering from this condition, effective treatment is available in the form of artificial urinary sphincter implantation.

References

  1. Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 2000;283:354-360.
  2. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008;358:1250-1261.
  3. Herr HW. Quality of life of incontinent men after radical prostatectomy [see comments]. J Urol 1994;151:652-654.
  4. Montague DK, Angermeier KW. Postprostatectomy urinary incontinence: the case for artificial urinary sphincter implantation. Urology 2000;55:2-4.
  5. Montague DK, Angermeier KW, Paolone DR. Long-term continence and patient satisfaction after artificial sphincter implantation for urinary incontinence after prostatectomy. J Urol 2001;166:547-549.
  6. Scott FB, Bradley WE, Timm GW. Treatment of urinary incontinence by implantable prosthetic sphincter. Urology 1973;1:252-259.
  7. Montague DK, Angermeier KW. Treatment of postprostatectomy urinary incontinence: the case against the male sling. Nat Clin Pract Urol 2006;3:290-291.