Urethral pressure controlled balloon refilling or balloon change for artificial sphincter secondary procedure?

OBJECTIVES: To report our experience of inflating or changing pressure balloon to treat recurrent urinary incontinence after AMS800® implantation instead of changing all the devices.

PATIENTS AND METHODS: A retrospective study was conducted in a tertiary reference center between 2005 and 2015. All patients, treated by AMS800® implantation for post-prostatectomy urinary incontinence and whom balloon was subsequently changed or inflated, were included. Main clinical end point was the need for another surgery. Secondary end points were urethral erosion, infection, and efficacy on pad test and pad use.

RESULTS: Thirty-one patients were included. All had had a 61-70cm H2 0 balloon implanted, with a single cuff (13 with transcorporeal placement). Twenty-one patients had their balloon changed for a 71-80cm H2 0 type, while 10 patients had their balloon refilled (median 3mL [range 2-7]). Median follow-up was 23 months (range 1-129). Overall rate of another subsequent surgery was 48.3% (n=15). Erosion and atrophy occurred more frequently after balloon repressurizing than after balloon replacement (80% vs 33%, P=0.024). At last follow-up, median pad use was higher in repressurizing group (2 vs 1, P=0.033).

CONCLUSION: Balloon repressurizing is associated with a higher erosion and reoperation rate than changing pressure balloon. Continence results seem better when PRB is changed. It could be an alternative instead of changing all devices in patients with frail urethra.

LEVEL OF EVIDENCE: 4.