Question 6#

Which is CORRECT for the artificial urinary sphincter (AUS)?

A. It is the method of choice to treat stress urinary incontinence secondary to neurogenic bladder dysfunction
B. In a patient with neuropathic bladder, the cuff should be placed at the bulbar urethral sphincter in a man and at the bladder neck in a woman
C. It must not be placed at the same time as a ‘clam’ cystoplasty due to the risk of device infection
D. The revision rate is equivalent in neuropaths and non-neuropaths
E. The infection rate is 10%

Correct Answer is A


Answer A

The bulbar urethra is the preferred cuff implantation site in post-prostatectomy incontinence. In neuropaths, in particular after spinal cord injury, patients are mostly wheelchair bound thus sitting with the whole-body weight on the bulbar urethra. Moreover, neuropathic patients often have an open bladder neck, especially in patients with infrasacral lesions. Consequently, the prostatic urethra is always filled with urine, which may possibly be a factor for recurrent infection and prostatic influx in male patients. Therefore, in neuropaths, the AUS cuff is placed at the bladder neck. The infection rate is 1%–5%. In non-neuropaths, the erosion rate is also 1%–5% but is higher in neuropaths. It is possible to place an artificial urinary sphincter at the same time whilst performing a cystoplasty. However, there can be an increased risk of infection and the patient must be warned accordingly