Success of de novo reimplantation of the artificial genitourinary sphincter

PURPOSE: We evaluate our experience with de novo reimplantation of the artificial genitourinary sphincter with a particular emphasis on mechanical and nonmechanical failure rates. De novo reimplantation is defined as implantation of an artificial sphincter following removal of a previously placed sphincter for erosion and/or infection and a waiting period of several months. MATERIALS AND METHODS: A retrospective analysis of more than 400 patients with an artificial sphincter revealed 23 who underwent de novo reimplantation between January 1983 and October 1998. All patients were men with a mean age of 66.5 years (range 16 to 88) and all had a urethral cuff. Reasons for cuff removal were erosion in 12 cases (52.2%), infection in 10 (43.5%) and intraoperative urethral injury in 1 (4.3%). Mean waiting period was 6.8 months (range 1.5 to 32) between explantation and de novo reimplantation. Mean followup was 32.6 months (range 1 to 108). RESULTS: Of the 23 patients 20 (87%) had no mechanical or nonmechanical failures and 3 (13%) had nonmechanical failures, including 2 patients (8.7%) whose cuff eroded into the urethra and 1 (4.3%) who had recurrent urinary incontinence which was successfully treated with implantation of a tandem cuff. There were no mechanical failures or infections in this group of patients. CONCLUSIONS: Our study suggests that de novo artificial sphincter reimplantation is an excellent treatment option. It is safe and associated with complication rates that are comparable to those of primary implantation.