From the Guidelines
For patients presenting with urinary incontinence and a scarred, open proximal urethra, artificial urinary sphincter (AUS) placement is the preferred treatment option.
Key Considerations
- The use of AUS is recommended due to its effectiveness in treating stress urinary incontinence, despite the potential for decreased efficacy over time and the need for reoperations 1.
- Male slings are not recommended for patients with a scarred, open proximal urethra, given the lack of compelling evidence of their effectiveness in this subgroup 1.
- Urethral bulking agents may be considered in patients who are unable to tolerate or refuse more invasive surgical therapy, but their efficacy is low and cure is rare 1.
Treatment Approach
- Initial evaluation and counseling should be provided to patients, discussing the potential benefits and risks of AUS placement, including the possibility of device malfunction and the need for reoperations 1.
- Patients should be informed that the failure rate of AUS increases with time, with failure rates of approximately 24% at 5 years and 50% at 10 years 1.
- In cases where AUS placement is not feasible or has failed, other surgical options such as urethral reconstruction may be considered, although the evidence for these approaches is limited 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Urinary Incontinence with a Scarred, Open Proximal Urea
- The treatment for a patient with urinary incontinence and a scarred, open proximal urethra is complex and requires careful consideration of the patient's specific condition and medical history.
- According to 2, 3, open retropubic colposuspension is a surgical treatment that involves lifting the tissues near the bladder neck and proximal urethra to correct deficient urethral closure, and it has been shown to be an effective treatment modality for stress urinary incontinence, especially in the long term.
- However, for patients with a scarred, open proximal urethra, the artificial urinary sphincter (AUS) may be a more suitable option, as it can provide continence restoration in men with compromised urethral tissue 4, 5.
- The transcorporal cuff (TC) placement is a technique modification that can be used to facilitate continence restoration in patients with previous failed AUS, urethroplasty, or pelvic radiotherapy, and the tunical flap (TF) technique provides circumferential reinforcement with tunica albuginea from the corpora cavernosa, which can help prevent cuff erosion 5.
Considerations for Treatment
- The choice of treatment depends on the patient's specific condition, medical history, and the severity of their symptoms.
- Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are necessary for high-risk patients 4.
- The patient's goals and desired outcomes should also be taken into account when considering treatment options 6.