Artificial urinary sphincter: current status and future directions / 亚洲男科学杂志(英文版)

Urge urinary incontinence (UUI) is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions. For many decades, there have been attempts to reduce the morbidity of this outcome with variable results. Since its development in the 1970s, the artificial urinary sphincter (AUS) has been the "gold standard" for treatment of the most severe cases of UUI. Other attempts including injectable bulking agents, previous sphincter designs, and slings have been developed, but largely abandoned because of poor long-term efficacy and significant complications. The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy. None of these changes in the basic AUS design have occurred in the past three decades, and the AUS remains the same despite newer technology and materials that could improve its function and safety. Recently, newer compressive devices and slings to reposition the bladder neck for men with mild-to-moderate UUI have been developed with success in select patients. Similarly, the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon (PRB) to reduce infection risk. The basic AUS design, however, has not changed. With newer electronic technology, the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported. While the eAUS is as yet not available, its development continues and a prototype device may be available soon. Possible design options are discussed in this review.

Artificial urinary sphincter: Current status and future directions / 亚洲男科学杂志(英文版)

Urge urinary incontinence (UUI) is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions. For many decades, there have been attempts to reduce the morbidity of this outcome with variable results. Since its development in the 1970s, the artificial urinary sphincter (AUS) has been the 'gold standard' for treatment of the most severe cases of UUI. Other attempts including injectable bulking agents, previous sphincter designs, and slings have been developed, but largely abandoned because of poor long-term efficacy and significant complications. The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy. None of these changes in the basic AUS design have occurred in the past three decades, and the AUS remains the same despite newer technology and materials that could improve its function and safety. Recently, newer compressive devices and slings to reposition the bladder neck for men with mild-to-moderate UUI have been developed with success in select patients. Similarly, the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon (PRB) to reduce infection risk. The basic AUS design, however, has not changed. With newer electronic technology, the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported. While the eAUS is as yet not available, its development continues and a prototype device may be available soon. Possible design options are discussed in this review.

A Case of Combined Implantation of Artificial Sphincter and Penile Prosthesis / 대한비뇨기과학회지

Concurrent sphincteric incontinence and organic impotence are not uncommon. Simultaneous implantation of the artificial sphincter and penile prosthesis is an effective proposal technically and functionally in these situations. A 44-year-old man presented with total incontinence and impotence, which developed after pelvic bone fracture. Urodynamic study showed sphincter incompetence. Pharmacologic & penile duplex sonography, nocturnal penile tumescence test confirmed arteriogenic impotence. Simultaneous implantation of an artificial sphincter(AMS 800) and a multicomponent inflatable penile prosthesis(AMS 700CXM) was done. For 5 months of follow-up the penile implant was functional, without incontinence. and there are no evidences of infection.

A Case of Urinary Incontinence Treated with AMS 800 Artificial Sphincter / 대한비뇨기과학회지

A 31 year old male patient presenting urinary incontinence 2 years after the traumatic injury of the posterior urethra and bladder neck, fails to respond to the alpha-adrenaergic agents and other ordinary methods. However, using the artificial sphincter(Model AMS 800) implantation, he successfully voided freely without urinary incontinence and the residual urine. The urethral closing pressure was significantly increased. The radiographic findings of inflation and deflation of the sphincter revealed satisfactory functions.

A Case of Urinary Incontinence Treatment Using AMS 800-Artificial Sphincter / 대한비뇨기과학회지

Urinary incontinence is one of the most distressing problems in urologic practice. However, recent advances in implantable devices have significantly improved the outlook for patients with incontinence due to sphincter weakness. Herein we report a case of urinary incontinence treated by artificial sphincter (model AMS 800) implantation. A 25-year-old man presented with continuous and total incontinence, which developed after pelvic bone fracture and urethral injury. cystometry was normal, uroflowmetry and urethrography showed no significant bladder outlet obstruction, and urethral closing pressure was significantly decreased. After artificial sphincter implantation to the bladder neck. the patient showed good results both clinically and urodynamically.