V3-01: Use of the Ohmmeter to Identify the Site of Fluid Leak During Artificial Urinary Sphincter Revision Surgery
VideoIntroductions and Objectives
Revision surgery for the malfunctioning artificial urinary sphincter (AUS) is necessary in up to 44% of patients and is a frustrating problem for patient and physician alike. Many techniques and algorithms have been described for troubleshooting the malfunctioning AUS, the etiology of which can include mechanical failure, urethral erosion, sub-cuff atrophy, and fluid leak from the device. Difficulty identifying the site of fluid leak leads many implanters to simply replace the device in its entirety. We have found the use of an ohmmeter to be consistently helpful in the identification and localization of the site of leakage from individual components of the AUS allowing for removal and replacement of individual AUS components.
The right lower quadrant incision site overlying the AUS tubing with connectors is opened and the tubing and connectors are identified and dissected. Rubber shod clamps are placed on the tubing on either side of the connectors on both the cuff and pressure regulating balloon (PRB) tubing. The tubing is cut. Fluid is aspirated from the balloon to confirm fluid loss. At this point, fluid is injected into the PRB and the ohmmeter leads are applied to the injection needle and the metal skin retractor (ground). Deflection of the ohmmeter needle indicates flow of fluid and identifies a leak in the PRB. This is repeated with the tube to the AUS pump as well as the cuff. Components that demonstrate a leak are replaced. A leak in the affected component is then confirmed on the back table. The device is reconnected and cycled under cystoscopic vision.
Intraoperative use of the ohmmeter has been used in 19 cases on 18 patients. Correct identification of the leak site was achieved in 18/19 patients (94.7%). In the one unsuccessful case, the entire device was removed and replaced. All 18 cases had satisfactory outcomes with no patients requiring further revision surgery for leakage. Four patients required subsequent cuff downsizing for sub-cuff atrophy at a median 19 months after initial revision surgery.
Our technique for identifying and localizing a fluid leak is highly reproducible and successful and has allowed for precise management of patients with AUS malfunction due to fluid loss.