Presentation Authors: Jack Andrews*, Brian Linder, Joseph Scales, Daniel Elliott, Rochester, MN
Introduction: While artificial urinary sphincter placement remains the gold standard treatment option for men with stress urinary incontinence, roughly a quarter of men will undergo device revision for recurrent incontinence. For patients undergoing single component device revision the surgical dogma has been to use suture-tie connectors exclusively, as opposed to the Sutureless Quick-ConnectorsÂ® (QC), which are routinely used in primary implantations. We sought to evaluate characteristics of artificial urinary sphincter mechanical failures and compare outcomes based on the use of either suture-tied connections or Quick-ConnectsÂ® for single component revisions.
Methods: A total of 1082 men with stress urinary incontinence underwent primary artificial urinary sphincter procedures from 1983 to 2011 at our institution. Of these, 125 experienced mechanical device malfunction, including 117 that underwent subsequent revision surgery at our institution. With regard to revisions, prior to 1996 all revision cases were performed with suture-tie connections and after this we used QC for revisions. Multiple clinical and surgical variables were evaluated for a potential association with repeat AUS surgery including the type of connector used.
Results: Of the 117 patients that underwent revision surgery for primary device malfunction, 46 were single component revisions. In these cases, the tubing connections were performed using suture-tie connectors in 34 (74%) cases and QC in 12 (26%) cases. The median follow-up after revision surgery was 24 months (IQR 7.2, 55.2).(Table 1) There was no significant difference in 5-year device survival between suture-tie and QC (36% vs 61%; p=0.85).(Figure 1) There were no cases of device infection or repeat mechanical failure at the connector among revision cases utilizing QC, as compared to five device infections and four repeat mechanical failures among the suture-tie cohort.
Conclusions: The use of Quick ConnectsÂ® for single component artificial urinary sphincter revision for mechanical failures appears to be safe, efficient and reliable. There is not enough evidence supporting the presence of an association between connector type with the risk of overall device failure.