Bladder neck artificial urinary sphincter (BN AUS) for recurrent or complex primary urodynamically proven stress and mixed urinary incontinence – outcomes from a tertiary referral centre
To assess the outcome of BN AUS insertion for recurrent or complex primary urodynamically proven stress urinary incontinence (SUI) and stress-predominant mixed urinary incontinence (MUI).
We retrospectively reviewed a prospectively collected database of women having BN AUS implantation by two surgeons for SUI and MUI. The type and aetiology of the incontinence, previous surgery, the type of procedure and the outcome in terms of cure and complications were recorded.
50 women with median age 50.5 years (range 27-69) had BN AUS implantation, as above, between 2006 and 2016. Of these, 34 had primary implants, 12 had a device replacement following mechanical failure and 4 had a new implant following previous explantation of an earlier device for erosion. The aetiology was neurological in 17, recurrent stress urinary incontinence in 16, epispadias in 6, pelvic fracture urethral injury in 4, bilateral single ectopic ureter in 3, urethrovaginal fistula in 1, augmentation urethroplasty in 1, congenital Mullerian anomaly in 1 and undiversion in 1. 43 had had previous surgery including cystoplasty, undiversion, urethroplasty, urethrovaginal fistula repair and anti-incontinence surgery. The results and complications are listed below according to whether the patient underwent a one stage implantation of all the device components; a staged procedure in which the bladder neck cuff was implanted at the first procedure and the remaining components were implanted and the device activated six months or so later; and patients in whom just the cuff alone was implanted (stage 1 of the staged procedure) but the patients became continent with that alone and didn’t require the rest of the components at a second stage.
BN AUS implantation has a 6% infection/erosion rate and a 22% chronic infection erosion rate leading to device explanation. For the 78% of women with functioning devices, incontinence is cured in 85% and improved in a further 10%. Only 2 patients remain wet and both have congenital anatomical abnormalities of the lower urinary tract.