Artificial Urinary Sphincter Implantation Improves Functional Outcomes in Women with Stress Urinary Incontinence
Introduction
Stress urinary incontinence (SUI) is a cause of concern in women affecting their quality of life (QoL). The artificial urinary sphincter (AUS) is the gold standard for the treatment of male moderate-to-severe SUI, its application in women is limited. The international urological societies recommend implantation of AUS as a second line treatment option due to lack of long-term data. The results of one meta-analysis on the AUS implantation in male SUI demonstrate good outcomes and high patient satisfaction. However, the existing data suggest that a significant proportion of women required revision operation after good initial results and that rate of revision increased with time.
Aim
The complication rate, continence rate and long-term results of AUS therapy was assessed in women with SUI.
Method
Study Design
- Systematic review and meta-analysis
Treatment Strategy
- Extensive literature search was conducted to validate the effectiveness of the AUS in women.
- Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to conduct the meta-analysis
- The meta-analysis included a total of 15 studies comprising 964 women with persistent SUI
- The quality of evidence was evaluated using The Newcastle-Ottawa score
- The success rate and complications associated with the AUS were assessed
Endpoints
Primary Endpoint
- Continence categorized as
- Complete continence (no leaking, no pads used)
- Social continence (1-2 pads/day)
- Improved continence (>50% decrease in the number of pads used)
- Failure (<50% improvement, persistent or increased leaking)
Secondary Endpoints
- Complications
- Explantation
- Revision-free time
Results
- Total continence rate after implantation of AUS, despite multiple previous surgeries, was 79.6%
- There was a significant improvement in 15%
- The mean follow-up duration was 22 months
- The mean number of patients per study was 68
- A small portion of the patients (15.42%) required a revision surgery (for various reasons including erosion, infection and mechanical failure)
- Overall, the complication rates were manageable, but the need for revision surgery increased over time.
- The mean (range) explantation rate was 13 (0–44)%
- Vaginal erosion occurred in a mean (range) of 9 (0–27)% and mechanical complications in 13 (0–47)%
- Infections contributed to 7% of the complications
- In term of device survival rate, AUS survival rate was found 87.1% and 78.9% at 2 and 5 years of follow-up, respectively.
Conclusion
- Artificial urinary sphincter implantation provided satisfactory long-term functional outcomes with manageable complications in women with SUI and is an effective treatment option after failure of first-line therapy.
- However, large population-based prospective studies are warranted.
Arab J Urol. 2020; 18(2): 78–87. Doi: 10.1080/2090598X.2020.1716293.
