Introduction: The management of suspected artificial urinary sphincter (AUS) sub-cuff atrophy remains controversial and clinical outcomes remain underreported. Our objective was to examine the impact of cuff downsizing on patient reported outcomes and pad use in cases of sub-cuff atrophy.
Methods: We reviewed our prospectively collected, institutional approved QI database from 2011 to 2021. IRB approval was obtained for the analysis. At our institution, the AUS is routinely filled with contrast solution and imaged radiographically upon initial activation for a baseline. This allows for better delineation between device failure or sub-cuff atrophy during standard multimodal workup of recurrent urinary incontinence with serial AP Pelvis radiography. Patients are seen on a routine basis following activation. Sub-cuff atrophy was diagnosed with serial AP pelvis films indicating atrophy, cystoscopy, assessment of symptom scores and pad use, and history and physical examination. Patients with post-prostatectomy incontinence who underwent cuff downsizing after the diagnosis of sub-cuff atrophy were included for analysis. Repeated measures T-tests were used to assess change in validated survey instruments, subjective outcomes measures and pad use.
Results: Over this time-period, 842 AUS devices were placed, 623 new and 219 revisions. Of these, 30 underwent cuff downsizing following a diagnosis of sub-cuff atrophy as determined by the appearance of more fluid in the cuff versus baseline on AP pelvis film, cystoscopy with incomplete coaptation, patient interview and questionnaires, and evaluation of number pads used per day. The initial AUS was in place for a median of 668 days (292, 1601) prior to the diagnosis of sub-cuff atrophy. Median follow up duration after cuff downsizing was 3561 days (2247, 4704). At time of most recent assessment, 23 (73.3%) of downsized cuffs remained in place, 2 (6.6%) were revised for mechanical failure, 2 (6.6%) for further atrophy and 3 (10.0%) for erosion. Following downsize, 96.7% reported subjective improvement and 92.0% experienced a decrease in pad count, with a median decrease of 2 and mean decrease of 2.21 (± 1.45) pads per day (p < 0.01). Of those who completed the AUA Symptom Score before and after downsize, 82% experienced an improvement on the bother index score (mean decrease 1.63 ± 1.74, median 1, p=0.01).
Conclusions: Cuff downsizing improves continence control and patient satisfaction in cases of multimodal diagnosed sub-cuff atrophy.
Source of Funding: Boston Scientific Fellowship Grant
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