Investig Clin Urol.  2018 Jul;59(4):275-279. 10.4111/icu.2018.59.4.275.

Proof of concept: Exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon

• Pearlman A
• Rasper AM
• Terlecki R

• KMID: 2414761
• DOI: http://doi.org/10.4111/icu.2018.59.4.275

Abstract

PURPOSE
Rate of continence after artificial urinary sphincter (AUS) placement appears to decline with time. After appropriate workup to exclude inadvertent device deactivation, development of urge or overflow incontinence, and fluid loss, many assume recurrent stress urinary incontinence (rSUI) to be secondary to nonmechanical failure, asserting urethral atrophy as the etiology. We aimed to characterize the extent of circumferential urethral recovery following capsulotomy and that of pressure regulating balloon (PRB) material fatigue in men undergoing AUS revision for rSUI.
MATERIALS AND METHODS
Retrospective review of a single surgeon database was performed. Cases of AUS removal/replacement for rSUI involving ventral subcuff capsulotomy and intraoperative PRB pressure profile assessments were identified.
RESULTS
The described operative approach involving capsulotomy was applied in 7 patients from November 2015 to September 2017. Mean patient age was 75 years. Mean time between AUS placement and revision was 103 months. Urethral circumference increased in all patients after capsulotomy (mean increase 1.1 cm; range 0.5-2.5 cm). Cuff size increased, remained the same, and decreased in 2, 3, and 2 patients, respectively. Six of 7 patients underwent PRB interrogation. Four of these 6 PRBs (66.7%) demonstrated pressures in a category below the reported range of the original manufacturer rating.
CONCLUSIONS
Despite visual appearance to suggest urethral atrophy, subcuff capsulotomy results in increased urethral circumference in all patients. Furthermore, intraoperative PRB profiling demonstrates material fatigue. Future multicenter efforts are warranted to determine if capsulotomy, with or without PRB replacement, may simplify surgical management of rSUI with reductions in cost and/or morbidity.

Keyword

Atrophy; Urinary incontinence; Urinary sphincter, artificial

MeSH Terms

Atrophy*
Fatigue
Humans
Male
Retrospective Studies
Urinary Incontinence
Urinary Sphincter, Artificial*

Figure

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  Fig. 1 (A) Urethra at site of initial cuff placement prior to capsulotomy with 3 cm urethral circumference. (B) Ventral capsulotomy performed via combination of sharp dissection and electrocautery. (C) Urethra at site of initial cuff placement after capsulotomy measuring 4 cm in urethral circumference, demonstrating restoration of urethral circumference.

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