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Purpose This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Methods Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Results Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74–81 years; median follow-up, 4.4 years; IQR, 3–6.9 years). Before downsizing, SUI was very severe (ICIQ score 19–21) or severe (ICQ score 13–18) in 80% of patients, moderate (ICIQ score 6–12) in 12%, and slight (ICIQ score 1–5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Conclusions Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.

Background: Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. Methods: In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan–Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. Results: Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). Conclusions: A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Methods: Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Results: Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by =50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Conclusions: Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks. [ABSTRACT FROM AUTHOR]

ObjectivesAn artificial urinary sphincter (AUS) is the gold standard for postoperative stress urinary incontinence (SUI). The transcorporal AUS (TC) placement constitutes the main salvage option in high-risk patients suffering from SUI with fragile urethras. The literature analyzing long-term outcomes with respect to explantation rates, continence, and erectile function is scarce.Methods and PatientsRetrospective data collection was performed in 2011. TC was applied according to a standardized protocol. TC was implanted after bulbar urethroplasty or double-cuff (DC) explantation. After TC placement, the tunica albuginea was closed in order to minimize the risk of postoperative bleedings and erectile dysfunction. Activation was performed 6 weeks postoperatively. Further follow-up (FU) was scheduled 6/24 months postoperatively and every 2 years thereafter. Primary/secondary endpoints were explantation/objective, subjective, and social continence rates. Objective or social continence was defined as the use of 0 pads/day or

Objective: This study aimed at evaluating the cost-utility of artificial urinary sphincter (AUS) in men affected by postprostatectomy severe urinary incontinence and identifying the most cost-effective alternative among the various devices analyzed in Italy. Methods: A 5-year cycles Markov model was developed to simulate the disease evolution. The analysis compared conservative therapy, ZSI 375®, single-cuff (SC) AMS 800TM, and double-cuff (DC) AMS 800TM. A Probabilistic Sensitivity Analysis (PSA) was performed. One thousand Monte Carlo simulations were conducted to generate the Cost-Effectiveness Acceptability Curve for each intervention strategy. A sensitivity analysis on the price of the device was conducted. Results: From the Italian National Health Service perspective, DC AMS 800TM was the most cost-effective alternative in comparison with conservative therapy, with an Incremental Cost-Effectiveness Ratio (ICER) value equal to € 12,893. From the NHS + patient perspective, both the AMS 800TM devices (SC and DC) were dominant in comparison with conservative therapy. From the societal perspective, ICER was dominant for all the alternatives considered in terms of cost-effectiveness. The PSA showed that DC AMS 800TM had a greater probability to be cost-effective with respect to the other strategies considered in the analysis. The sensitivity analysis on the price of the device showed that in all the cases analyzed the incremental cost per QALY gained would be below € 25,000. Conclusions: This cost-utility analysis confirms that AUSs are cost-effective options in the Italian context with respect to conservative therapy. Among AUSs, DC AMS 800TM has the greatest probability to be cost-effective.

Purpose The aim was to study the correlation between cuff size and outcome after implantation of an AMS 800 artificial urinary sphincter. Methods A total of 473 male patients with an AMS 800 sphincter implanted between 2012 and 2014 were analyzed in a retrospective multicenter cohort study performed as part of the Central European Debates on Male Incontinence (DOMINO) Project. Results Single cuffs were implanted in 54.5% and double cuffs in 45.5% of the patients. The cuffs used had a median circumference of 4.5 cm. Within a median follow of 18 months, urethral erosion occurred in 12.8% of the cases and was associated significantly more often with small cuff sizes (P

Objectives: The artificial urinary sphincter (AUS) is the gold standard treatment for severe stress urinary incontinence (SUI). According to the literature, patients suffering from Parkinson's disease (PD) or stroke (ST) show adverse continence outcomes after prostate surgery and, therefore, constitute a challenging cohort for continence surgery. However, little is known with respect to the results of AUS surgery in these patients. A retrospective analysis of our institutional, prospectively maintained AUS database aims to address this aspect with a focus on surgical and functional outcomes. Methods and Patients: All data of patients with an AUS implantation were prospectively collected in our database since 2009. The AUS was implanted according to a standardized protocol and activated at 6 weeks postoperatively at our institution. Further follow-up (FU) consisted of pad-test, uroflowmetry, residual urine, and radiography as well as a standardized questionnaire including the Incontinence Quality of Life questionnaire (I-Quol) and International Consultation on Incontinence questionnaire (ICIQ-SF) and is scheduled at 6 and 24 months and every 2 years thereafter. Patients received a preoperative urodynamic evaluation (UD). Patients with normal voiding and storage function were considered for AUS implantation. All patients performed a preoperative test for manual dexterity. Patients with a history of ST or PD were grouped and compared to nonneurological patients. Primary/secondary endpoints of the study were complications/continence. Results: 234 patients were available for analysis. The median FU was 24 months (interquartile range 7–36). Twenty-four patients (10%) had a neurological history (PD and ST). Neurological patients showed significantly worse outcomes regarding continence (objective/subjective/social continence; p = 0.04/p = 0.02/p = 0.1). Significant differences concerning explantation rates were not observed (p = 1). Kaplan-Meier analysis showed no significant difference regarding explantation-free survival (log-rank p = 0.53). Conclusion: AUS implantation shows significantly worse continence rates for neurological patients, despite the fact that all patients showed normal UD results and sufficient manual dexterity. Although neurological patients showed worse outcomes for continence, AUS implantation seems to be a safe and viable treatment for patients with a history of neurological disease. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether salvage artificial urinary sphincter (AUS) implantation after prior incontinence surgery achieves outcomes comparable to primary AUS implantation. Methods: We retrospectively evaluated data of patients undergoing AUS implantation from 2009 to 2014. Functional outcome was objectified by 1-h stress pad test, uroflowmetry, post-void residual urine measurement, clinical examination, and chart review. Complications were categorized according to Clavien–Dindo classification system. Kaplan–Meier analysis determined explantation-free survival. Results: A total of 235 patients were included of whom 165 (70.2%) underwent primary AUS. In 70 patients, salvage incontinence surgery was performed, with 24 (10.2%) patients undergoing AUS reimplantation after prior AUS surgery (repeat AUS) and 46 (19.6%) patients undergoing AUS surgery after any other type of incontinence surgery (secondary AUS). There were no significant differences in rates of continence among primary AUS and repeat AUS patients. Patients undergoing secondary AUS had significantly better continence rates than primary and repeat AUS patients. Three-year explantation-free survival rates after AUS insertion were 82.3% (primary AUS), 78.6% (repeat AUS) and 81.5% (secondary AUS). There were no differences in complication rates among the groups. Conclusion: AUS is a safe option in the treatment of severe incontinence even after prior AUS or any other prior incontinence surgery and can still achieve satisfactory outcomes as salvage treatment. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to study the correlation between cuff size and outcome after implantation of an AMS 800 artificial urinary sphincter. Methods: A total of 473 male patients with an AMS 800 sphincter implanted between 2012 and 2014 were analyzed in a retrospective multicenter cohort study performed as part of the Central European Debates on Male Incontinence (DOMINO) Project. Results: Single cuffs were implanted in 54.5% and double cuffs in 45.5% of the patients. The cuffs used had a median circumference of 4.5 cm. Within a median follow of 18 months, urethral erosion occurred in 12.8% of the cases and was associated significantly more often with small cuff sizes (P<0.001). Multivariate analysis showed that, apart from cuff size (P=0.03), prior irradiation (P<0.001) and the penoscrotal approach (P=0.036) were associated with an increased erosion rate. Continence rate tended to be highest with median cuff sizes (4-5.5 cm). Conclusions: Apart from irradiation and the penoscrotal approach, small cuff size is a risk factor for urethral erosion. Results are best with cuff sizes of 4.5-5.5 cm. [ABSTRACT FROM AUTHOR]

Objectives: To analyze functional outcomes and complication rates of artificial urinary sphincter (AUS) implantation in patients who had undergone buccal mucosa graft urethroplasty (BMGU) beforehand. Patients and methods: This prospectively maintained single-center database comprises data from 236 patients from 2009 to 2015 who underwent AUS implantation. A total of 17 patients after BMGU were available for analysis. Primary endpoints consisted of continence and complication rates. Continence was defined as no use of safety pads, social continence as < 2 pads per day. Stricture recurrence was defined as a decrease in uroflowmetry, a maximum flow rate < 10 ml/s or residual urine volume (> 100 ml). Kaplan–Meier analysis determined explantation-free survival. Results: Median follow-up was 24 months (interquartile range [IQR] 6–31 months). Indication for AUS implantation was severe urinary incontinence with a history of radical prostatectomy (RRP) in 8 (47.1%), trauma in 1 (5.9%) and TUR-P in 8 (47.1%) patients. Pelvic irradiation was reported in 13 (76.5%) cases. The median length of buccal mucosa graft for urethroplasty was 4 cm (3–5 cm). A double cuff was implanted in 14 patients (82.4%), 3 patients received a single cuff. Complete and social continence was achieved in 76.5% and 100% of the patients, respectively. There was no significant difference in complications and explantation-free survival (log-rank, p = 0.191) between patients who had undergone BMGU before AUS compared to patients with no history of BMGU. Conclusions: According to the prospective follow-up data in a homogenous cohort, AUS implantation seems to be a viable, safe and effective therapeutic strategy for incontinence treatment despite previous BMGU. [ABSTRACT FROM AUTHOR]

Study design: Retrospective, non-randomised, single-centre study. Objectives: Comparative study of urodynamic tests in patients presenting social continence after AMS 800 or ZSI 375 insertion. Materials and methods: Study was open to patients with social continence, implanted with AMS 800 or ZSI 375. Vesical pressure (VP), urethral functional length (FL), maximal urethral pressure (MUP), maximal urethral closure pressure (MUCP), maximal urinary flow rate (Qmax) were registered with standard urodynamic equipment. Results: From March 2012 to September 2014, 27 male patients with AMS 800 and 28 with ZSI 375 were recruited. In the AMS 800 group mean VP was 25.03 cmH2O (range 13-47), mean FL 31.96 mm (range 20-52), mean MUCP 88.29 cmH2O (range 32-160), mean MUP 119.55 cmH2O (range 77-180), mean Qmax 22.86 mL/s (range 5.6-54.6). In the ZSI 375 group, mean VP was 24.89 cmH2O (range 6-40), mean FL 30.53 mm (range 12-87), mean MUCP 70.11 cmH2O (range 38-108), mean MUP 99.89 cm H2O (range 63-134), and mean Qmax 19.25 mL/s range (7.3-39.6). Discussion: Results of urodynamic tests are similar for both artificial urinary sphincters. AMS 800 cuff pressure over 70 cmH2O could be explained by the pelvis pressure and the difference of altitude between the pressure-regulating balloon (PRB) and the cuff. ZSI 375 pressure-regulating tank (PRT) is not influenced by these factors. Very high MUP could be explained with too tightened cuffs. Conclusions: AMS 800 and ZSI 375 urodynamic tests are similar. Pressure of the pelvis and difference of altitude between the AMS balloon and the cuff can lead to high MUP. [ABSTRACT FROM AUTHOR]

Darbo tikslas Remiantis literatūros duomenimis, apžvelgti dirbtinio šlapimo pūslės sfinkterio AMS 800 implantavimo rezultatus gydant įtampos (streso) šlapimo nelaikymą. Įvertinti prietaiso implantavimo indikacijas, kontraindikacijas, paciento paruošimą ope­racijai, operacijos techniką, komplikacijas. Medžiaga ir metodai Apžvalga buvo atlikta remiantis naujausia literatūra, pateikiama PubMed duomenų bazėje. Rezultatai Literatūros duomenimis, dirbtinio šlapimo pūslės sfinkterio AMS 800 efektyvumas įvairuoja nuo 61 % iki 100 %. 80–90 % ope­ruotų pacientų pagerėja gyvenimo kokybė, jie yra patenkinti operacija ir ją rekomenduotų kitiems. Komplikacijos yra palygin­ti retos, pasitaiko nuo 1 % iki 31 % atvejų. Tikimybė, kad AMS 800 dirbtinis sfinkteris garantuotai veiks 5 metus, yra 59–79 %. Išvados AMS 800 dirbtinis sfinkteris yra laiko patikrintas ir laikomas auksiniu standartu gydant vidutinio ir didelio laipsnio įtampos šlapimo nelaikymą. Tinkamai ištyrus pacientą, pasiekiami puikūs gydymo ir paciento pasitenkinimo operacija rezultatai, labai pagerėja gyvenimo kokybė.

Implantation of an artificial urinary sphincter (AUS) is the treatment of choice for managing severe stress urinary incontinence. This hydromechanical implant mimics a healthy sphincter by exerting a constant circumferential pressure around the urethra to close it and keep urine in the bladder. Common complications experienced with this device are urethral atrophy, erosion, and mechanical breakdown. Furthermore, AUS operation requires some dexterity resulting in difficulty and discomfort of use, and limiting the implantation in some patients. We present in this study a novel remote-controlled electromechanic AUS allowing rapid and effortless sphincter operation. Its design eliminates the classic manual pump, enhancing reliability, easing implantation in men and women, and achieving compatibility with already-implanted AUS. The device has been tested in vitro and ex vivo on fresh pig bladders. Different occlusive cuff pressure (OCP) ranges were employed and expected performance was obtained. Experimentation results and design challenges are reported and discussed here in. [ABSTRACT FROM PUBLISHER]

Severe stress urinary incontinence is a nonnegligible complication that affects men as well as women. When initial therapies are not sufficient, implantation of artificial urinary sphincters (AUS) is considered the gold standard treatment. This hydromechanical device applies constant pressure on the urethra to keep urine inside the bladder. Although recovery from incontinence is full or partial, this approach has certain disadvantages. In addition to the difficulties and discomfort encountered when operating the device, insufficient pressure, urethral atrophy, and erosion from constant pressure on the urethra may necessitate revision surgery. In this study, we present a novel, remote-controlled AUS with variable urethral pressure that improves continence and avoids revision surgery. The proposed design eliminates the manual pump, facilitating implantation in men and women. It is compatible with current AUS. The device requires very little power and its parameters can be monitored and updated post-operatively. It has been tested on pig bladders ex vivo. Different pressure control algorithms have been developed, and expected performances have been achieved. Design challenges and experimentation results are reported. [ABSTRACT FROM PUBLISHER]

Objective. In severe cases of stress urinary incontinence (SUI), with sphincter dysfunction, the artificial urinary sphincter AMS 800™ may be the last solution. The purpose of this study was to evaluate the outcome of surgical intervention for SUI with the AMS 800 in patients who were treated at Sahlgrenska University Hospital, Gothenburg. The primary aim of the study was to determine the complications related to the operation. Material and methods. A retrospective follow-up was done by reviewing medical records. The material comprised 97 men, who underwent their first AMS 800 implantation between May 1997 and June 2010 at Sahlgrenska University Hospital. Results. The revision rate was 28%, including an infection rate of 3% and an erosion rate of 7%. The mean follow-up for revised patients was 3 years. The median time until revision was 1 year. Seventy-five per cent of all patients were satisfied with the operation at 6 months' follow-up. Radical prostatectomy was the reason behind incontinence in 84% of patients in this series. Conclusion. The results clearly demonstrate a need for revision procedures in a considerable proportion of patients implanted with an AMS 800 device. Patient satisfaction was high, but although this operation has extremely low mortality it has its complications and the system will need to be replaced in time. [ABSTRACT FROM AUTHOR]

Implantation of artificial urinary sphincters (AUSs) is considered to be the gold standard treatment in severe cases of stress urinary incontinence. The functioning of these implants is purely hydromechanical, as they apply constant pressure around the bulbous urethra. Common reasons for device revision are insufficient cuff pressure and, in contrast, urethral atrophy secondary to this constant pressure. Furthermore, functioning requires some dexterity, limiting their implantation in some patients. We present in this study a novel electronic AUS that offers the possibility of remotely controlling the sphincter rapidly and without mechanical effort. The implant's embedded software can also be updated remotely. Its design eliminates the manual pump, making implantation easier in men and women. Furthermore, it is compatible with already-implanted AUS and can be employed for treating other sphincter deficiencies. The device has been tested on a custom test bed and on pig bladders in vitro. Different occlusive cuff pressure ranges were employed and acceptable performance was obtained. Design challenges and results are reported and discussed here. [ABSTRACT FROM PUBLISHER]

Study Type - Therapy (case series) Level of Evidence 4 Artificial urinary sphincter (AUS) implantation is one of several surgical options for the treatment of female stress urinary incontinence. It is indicated for women with both clinically and urodynamically defined intrinsic sphincter deficiency that significantly affects quality of life. The erosion/revision risk increases after several previous surgical interventions. Therefore, women believed to be candidates for AUS implantation should be rapidly (after the failure of a maximum of two previous surgical procedures) referred to specialized centres, where the knowledge and experience concerning the diagnosis, surgery and management of female stress urinary incontinence is concentrated. To refer correctly, non-academic urologists/gynaecologists should also be well informed about AUS implantation. Only in this way can the patient weigh the high long-term success rate and high quality of life improvement of AUS implantation against the greater complication/revision risk and take a well-considered decision. [ABSTRACT FROM AUTHOR]

Study design:Retrospective analysis.Objectives:To evaluate long-term efficacy and complications of AMS 800 (American Medical Systems®) artificial urinary sphincter (AUS) in treatment of urodynamic stress incontinence (USI) in male patients with spinal cord lesion (SCL).Setting:London Spinal Injuries Unit, Stanmore, UK and Institute of Urology and Nephrology, London, UK.Patients and methods:A retrospective analysis identified nine males with SCL (five thoracic, three lumbar, one cervical) with USI, who underwent AMS 800 AUS implantation by a single surgeon at a specialist spinal injuries unit. The mean age was 38.2 years (range 27–47 years), with the mean time since injury of 13.8 years (range 6–26 years). In all, seven were complete and two were incomplete SCL (traumatic spinal injury eight, tranverse myelitis one). All implants were inserted with the urethral cuff around the bulbar urethra with a 61–70 cm water pressure reservoir in the retropubic space. Implant activation was carried out at 6 weeks postoperatively. All patients were regularly followed up in outpatient clinics at the interval of 3 months, 6 months and yearly thereafter. An ultrasound examination for the upper tracts and a video-cystometrogram (VCMG) was carried out at 3 months postsurgery and then yearly.Results:The follow-up ranged from 3 to 133 months (mean 70.2 months). All implants were activated successfully with no intra- or immediate-postoperative complications. At activation all patients reported total urinary continence with seven out of nine implants (77%) currently working well. Two patients reported significant recurrent incontinence at 3 month follow-up, one of whom underwent a removal of the entire implant at the end of 3 months and the other was continent after a pump and cuff revision. The implant removed at 3 months was due to erosion and infection while the second was removed at 24 months due to secondary implant infection. Three out of seven (43%) successful implants required one revision each. One patient continues to report minimal leakage only during transfers with no leak demonstrated on postoperative VCMG. One patient with indwelling urethral catheter, two with suprapubic catheter and one voiding on urge have changed their bladder management to intermittent catheterisations postoperatively. All removals and revision procedures were carried out in the first 53 months of follow-up and four out of seven implants (57%) required no revisions.Conclusion:On a long term, AMS 800 is a viable option to treat USI in men with SCL. Mechanical revisions are frequent but effective. Strict patient selection, optimum preoperative bladder management and regular follow-up ensure low complication and high efficacy rates in the long term.Spinal Cord (2006) 44, 297–300. doi:10.1038/sj.sc.3101843; published online 25 October 2005 [ABSTRACT FROM AUTHOR]

STUDY DESIGN::Case report of an unusual use of AMS 800 (American Medical Systems, Inc., Minnetonka, Minnesota) artificial urinary sphincter cuff in a female patient affected by neurogenic urinary incontinence. OBJECTIVE::To describe this rare surgical solution. SETTING::Department of Urology in Italy. METHODS::A 43-year-old woman affected by flaccid paraplegia, acontractile bladder and incompetent bladder neck, underwent an implantation of an artificial urinary sphincter AMS 800. After 7 years, a mechanical failure of the device occurred and pubovaginal sling (PVS) utilizing the cuff of the sphincter was employed due to the poor quality of rectus fascia and the development of previous allergy for some heterologous materials. RESULTS::At 17 months follow-up, the patient is contnent and able to empty the bladder by clean intermittent self-catheterization (CIC). CONCLUSION::The risk of developing an allergy reaction due to the employment of heterologous materials and the impossibility to use the rectus fascia obliged us to adopt the pre-existent cuff of the artificial urinary sphincter AMS 800.Spinal Cord (2004) 42, 652-654. doi:10.1038/sj.sc.3101624; Published online 13 July 2004 [ABSTRACT FROM AUTHOR]

Context: Radical prostatectomy is the most common reason for male stress urinary incontinence. There is still insecurity about its therapeutic management., Objective: To evaluate current evidence regarding therapy of postprostatectomy incontinence (PPI)., Evidence Acquisition: In October 2017, a nonsystematic review of the literature published within the last 2 yr was performed using the PubMed/Medline database. In total, 58 articles were included in the current analysis., Evidence Synthesis: Regarding invasive management of moderate-to-severe PPI, artificial urinary sphincter (AUS) is still the treatment of choice. Recent studies focused on efficacy, but also a plethora of potential predictive features for treatment success has been investigated. Owing to inconsistent results, there still is no consensus about valid risk factors of AUS treatment success to date. There are increasing efficacy data about the use of adjustable slings, and long-term follow-up results are now available for the AdVanceXP male sling. Evidence addressing the use of the quadratic Virtue male sling needs further evaluation. To date, there is no randomized controlled trial investigating the outcome of one specific surgical treatment or comparing the outcome of different surgical treatment options. Limitations include the nonsystematic approach., Conclusions: Level of evidence addressing the surgical management of PPI is increasing but still unsatisfying., Patient Summary: In this review article, we look at current research regarding surgical management of stress urinary incontinence following radical prostatectomy. Many studies focus on how to predict treatment failure and outcomes after artificial urinary sphincter implantation. In addition, more information on the long-term results after male sling implantation is now available., (Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.)