Hi in this video we'll continue talking about the artificial urinary sphincter, we'll talk
about the success rate of the procedure as well as the complication rates and the satisfaction
rates. Most studies in the literature report success rate around 80% of patients achieve
social continence, this is usually defined by patients wearing 0-1 pad/day. A recent
systematic review published in European Urology Journal indicated that the rate of social
continence is between 60-100%. However the reported dry rate in the same systematic review
was much lower than that, it was around the 43% mark. In terms of complications, the most
widely reported complications are infection and that happens in about 4% of patients,
if that happens the device will need to be removed and replaced with another device after
the infection settles on antibiotic treatment, Erosion is another complication and this means
that the cuff of the artificial urinary sphincter can erode through the urethra or puncture
the urethra, and if this happens again the cuff will need to be removed and the area
allowed time to heal, then another cuff will be implanted, usually in different place either
more proximally or more distally, this also happens in about 4-5% of patients. The third
reported complication is urethral atrophy, which means that the urethra underneath the
cuff can shrink because of the continuous pressure and that makes the cuff loose and
ineffective, if that happens the cuff will need to be removed and replaced with another
smaller cuff, which is called downsizing the cuff. These three complications are usually
grouped under the title Non-mechanical failure, the other group is the mechanical failure,
because the artificial urinary sphincter is a mechanical device, any part of the device
can fail either the pump or the cuff or the balloon and if that happens part of the device
or the whole device will need to be replaced. common reasons for failure are leakage of
fluid via the tubes or puncture of the balloon and leakage of the fluid. In total the rate
of revision surgery after the insertion of the artificial urinary sphincter can be anywhere
between 14 to 45%of patients. These reported complications of non-mechanical and mechanical
failure are considered one of the main downsides of the procedure. however despite needing
maintenance surgery within 10 years most patients are well satisfied after the insertion of
the artificial urinary sphincter with reported satisfaction rate ranging between 85 to 90%.
So to recap the artificial urinary sphincter is an effective treatment for male stress
urinary incontinence after prostate surgery especially severe incontinence, however the
downside of the device that it has a significant complication rates and revisional surgery
rate. Despite that patients are well satisfied after the insertion of the sphincter because
it does restore patients' quality of life. I hope you found this video useful and I apologise
for the poor quality of the voice.