Abstract
PURPOSE: Recurrent stress incontinence (SUI) in patients with an artificial urinary sphincter (AUS) is a diagnostic challenge. History, physical exam and office cystoscopy are often inadequate for determining the cause of device related issues. Our objective is to describe our experience with contrast use in the AUS and how this can aid in diagnosing mechanical failure. MATERIALS AND METHODS: A retrospective evaluation of patients undergoing primary AUS placement from 1983 to 2022 was performed. We present our surgical technique for AUS placement and standard workup algorithm for patients with recurrent SUI. In our practice, standard evaluation includes history and physical, flexible cystoscopy with the cuff deactivated, and X-ray film of the abdomen and pelvis. Patients with device malfunction are identified via loss of contrast from the AUS system on X-ray. Device survival is presented via Kaplan-Meier method. RESULTS: During the study, 1,635 patients underwent primary AUS placement with a median (interquartile range [IQR]) follow-up of 4.26 years (1.0, 9.0). Of these, 220 patients (13.5%) were found to have mechanical failure with loss of contrast from the AUS system on X-ray imaging. The median time to mechanical device failures was 4.98 years (IQR 2.4, 9.2). Devices free of mechanical malfunction was 97.6% at 1 year and 89.6% at 5 years. CONCLUSIONS: The differential diagnosis of recurrent SUI after AUS includes multiple device related issues. Filling the AUS with iso-osmotic contrast is an effective way to diagnose mechanical failure. We present our technique as a useful adjunct for other AUS surgeons.