Stress urinary incontinence (SUI) is a disabling condition and can have a significant impact on quality of life. Recurrent SUI after synthetic or autologous sling surgery can be challenging due to low risk of success and high complication rate. The literature regarding the artificial urinary sphincter (AUS) in women is limited. The goal of this descriptive study is to get insight into functional outcome, patient satisfaction and quality of life after AUS placement in female patients with recurrent SUI.

A retrospective study was performed analyzing female patients who received a AUS between 2011 and 2017. Procedures were performed by a single urologist, in a one academic center. Patients with SUI with more than one incontinence procedure prior to AUS placement were included. Post-operative incontinence was quantified by daily pad usage and was compared to pad use prior to the procedure. Patient satisfaction was evaluated by a survey and was scored on a five-point scale (0 = unsatisfied, 4 = very satisfied). The post-operative symptom burden was measured using Urogenital Stress Inventory (UDI-6), the quality of life was measured by use of the Incontinence Impact Questionnaire (IIQ-7). Both instruments have been validated for assessment of incontinence in women. [1]

In total, 15 AUS implantations in 13 women (mean age of 64.5 years (+- SD 5.9)) were performed. Two patients underwent a cuff revision after previous AUS placement. In 2 patients (one after transvaginal tape procedure complicated by bladder neck erosion and one after resection of pelvic lymphoma) an omentoplasty was performed. Nine patients (69%) had undergone 2 or more SUI procedures prior to AUS. Of all patients, 12 have reported to be (very) satisfied.  The average daily pad usage decreased from pre-operative 6 to post-operative 0.9 (P<0.001). Eight patients (62%) had no pad usage post operatively. The average postoperative UDI-6 score was 2.2 and IIQ-7 score 3.2

The AUS in female patients with recurrent SUI and can provide beneficial results regarding functional outcome, patient satisfaction and quality of life.

AUS can be considered a good option in women with recurrent SUI, even after failure of multiple surgical procedures.

Utomo E. et al. Validation of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) in a Dutch population. Neurourol Urodyn. 2015 Jan;34(1):24-31.