The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 year actuarial adequate function rates

Objective. To determine the success (as both continence and revision rates) of the artificial urinary sphincter (AUS) in men incontinent after radical prostatectomy, and thus improve the preoperative counselling provided for these patients. Patients and methods. The AUS was implanted in 27 men incontinent after radical prostatectomy (mean age 69 years, range 59-75) at a mean (range) interval of 20 (4-60) months after surgery. The Kaplan-Meier method of survival analysis was used to determine the 'primary adequate function' (PAF) rate and the 'additional procedure-assisted adequate function' (APA-AF) rate. Adequate function was defined as satisfactory continence (use of at most one pad per 24 h) in combination with good AUS function. PAF was defined when no revisions of the AUS were required and APA-AF when one or more revisions of one or more parts of the AUS were required; a complete exchange or explantation of the AUS defined failure, i.e. the end of APA-AF. Results. At a mean follow-up of 35 months, 81% of the patients had achieved satisfactory continence. However, the 5 year PAF and APA-AF rates, based on the Kaplan-Meier curves, were 49% and 71%, respectively. Conclusions. Implantation of an AUS can provide excellent continence rates in patients incontinent after radical prostatectomy, but only at the expense of a considerable re-operation rate. The outcome is best represented by Kaplan-Meier curves of the PAF and the APA-AF.