PURPOSE: Many patients with persistent incontinence after an AUS procedure gain improved continence following cuff downsizing.
In 2010 a new, smaller AUS cuff was introduced (3.5cm). We hypothesized that men with spongiosal atrophy previously treated with a 4.0cm cuff now have decreased rates of revision surgery due to more accurate cuff sizing.
MATERIALS AND METHODS: We evaluated outcomes of men receiving identical 4.0 cm cuff sizes in two eras - before (2007-2009) and after (2010-2013) the introduction of the 3.5cm AUS cuff. Patients with transcorporal, tandem, ≥4.5cm cuffs, or a history of cuff erosion were excluded. We validated our institutional results with a nationwide AMS PIF database from identical time frames.
RESULTS: Of 236 men who underwent AUS placement at our institution during the study period, 170 (mean age 67 yrs) met inclusion criteria; 88/170 (52%) received 4.0cm AUS cuffs (mean follow-up 34 mo). Among 45 patients having 4.0cm cuffs placed from 2007-2009, 10 (22.2%) required cuff downsizing for persistent incontinence while only 2/43 (4.7%, p< 0.001) of men receiving 4.0cm cuffs from 2010-2013 required revisions. Nationwide, patients receiving 4.0cm cuffs had fewer revisions during the latter era (16.2% vs. 7.5%, p=0.001). Kaplan-Meier analysis demonstrated improved cuff survival for the 4.0 cm cuff after introduction of the 3.5cm cuff (p< 0.05) in both local and national cohorts.
CONCLUSIONS: AUS revision surgery in 4.0cm cuff patients has decreased since the availability of the 3.5cm cuff suggesting that precise cuff sizing appears to be beneficial for men with spongiosal atrophy.
Written by:
Simhan J, Morey AF, Zhao LC, Tausch TJ, Scott JF, Hudak SJ, Mazzarella BC. Are you the author?
Department of Urology, UT Southwestern Medical Center Dallas, TX.
Reference: J Urol. 2014 Apr 15. pii: S0022-5347(14)03340-0.
doi: 10.1016/j.juro.2014.03.115
PubMed Abstract
PMID: 24746880
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