Decreasing need for artificial urinary sphincter revision surgery by precise cuff sizing in men with spongiosal atrophy

Purpose Many patients with persistent incontinence after an artificial urinary sphincter procedure gain improved continence after cuff downsizing. In 2010 a new, smaller (3.5 cm) artificial urinary sphincter cuff was introduced. We hypothesized that men with spongiosal atrophy previously treated with a 4.0 cm cuff would now show a decreased rate of revision surgery due to more accurate cuff sizing. Materials and Methods We evaluated the outcome in men who received identical 4.0 cm cuff sizes in 2 eras, before (2007 to 2009) and after (2010 to 2013) the introduction of the 3.5 cm artificial urinary sphincter cuff. Patients with a history of cuff erosion or those undergoing tandem, transcorporal, or 4.5 cm or greater cuff placement were excluded from analysis. We validated our institutional results using the nationwide AMS® PIF (Patient Information Form) database from identical time frames. Results Of 236 men who underwent artificial urinary sphincter placement at our institution during the study period 170 with a mean age of 67 years met study inclusion criteria, of whom 88 (52%) received a 4.0 cm artificial urinary sphincter cuff. Mean followup was 34 months. Ten of 45 patients (22.2%) who had a 4.0 cm cuff placed from 2007 to 2009 required cuff downsizing for persistent incontinence while only 2 of 43 (4.7%) who received a 4.0 cm cuff from 2010 to 2013 required revision (p <0.001). Nationally patients with a 4.0 cm cuff underwent fewer revisions during the latter era (16.2% vs 7.5%, p = 0.001). In local and national cohorts Kaplan-Meier analysis revealed improved survival of the 4.0 cm cuff after the introduction of the 3.5 cm cuff (p <0.05). Conclusions The incidence of artificial urinary sphincter revision surgery in patients with a 4.0 cm cuff has decreased since the availability of the 3.5 cm cuff. This suggests that precise cuff sizing appears to be beneficial in men with spongiosal atrophy.