Ross Cartmill

Newer and novel artificial urinary sphincters (AUS): the development of alternatives to the current AUS device

The current artificial urinary sphincter (AUS), AMS 800™ (American Medical Systems, Minnesota, MN, USA) is considered the standard of care for the treatment of urinary incontinence (UI). While the long‐term effectiveness, safety, and durability of the current model of the AMS 800 are well documented, it is not without its limitations and complications. Over the last few years, improvements in design and innovative research into AUS devices have increased the treatment arsenal in male UI.

25-year experience in the outcome of artificial urinary sphincter in the treatment of female urinary incontinence

Study Type – Therapy (outcomes research)u2028Level of Evidenceu20032c

Evaluation of clinical efficacy, safety and patient satisfaction rate after low-intensity extracorporeal shockwave therapy for the treatment of male erectile dysfunction: an Australian first open-label single-arm prospective clinical trial

To evaluate the efficacy, safety and patient satisfaction rate with low‐intensity extracorporeal shockwave therapy (LiESWT) in Australian men with erectile dysfunction (ED), as LiESWT induces neovascularisation and potentially enhances penile perfusion and improves erectile function.

Penile prosthesis implantation for the treatment for male erectile dysfunction: clinical outcomes and lessons learnt after 955 procedures

PurposeTo evaluate the clinical outcomes of penile prosthesis implantation for the treatment for erectile dysfunction (ED) over 3 decades in a centre of excellence.MethodsA total of 955 penile prostheses were implanted between June 1981 and June 2010. The mean age of the men was 53.2 (28–80) years, and the mean follow-up was 76 (12–355) months. A total of 771 men had primary implants. The most common implant was Ultrex cylinder (54xa0%), and the main cause of ED was organic (32xa0%).ResultsPrimary implants showed higher rate of intra-operative complications than revision surgery (3.5 vs. 0.1xa0%) (pxa0<xa00.05). Prosthesis infection occurred in 0.8xa0% and equal incidence between diabetic and pelvic trauma patients. The average time to prosthetic revision was 102 (30–210) months. Kaplan–Meier estimates of overall penile prosthesis survival at 5 and 10xa0years were around 90.8 and 85.0xa0%. The most common mechanical failures were fluid loss (75xa0%). The majority of men were satisfied with the surgical outcomes, and 90xa0% of men would undergo penile prosthesis implant again.ConclusionsPenile prosthesis surgery is a safe and durable treatment option for male ED. Strict adherence to antimicrobial prophylaxis and surgical practice is paramount to ensure low complication rates and high patient satisfaction rate.

Diagnostic challenges in the evaluation of persistent or recurrent urinary incontinence after artificial urinary sphincter (AUS) implantation in patients after prostatectomy

There is a lack of information pertaining to the postoperative evaluation in patients with artificial urinary sphincter (AUS) implants who complain and continue to have urinary incontinence (UI). Two types of UI can occur after the activation of an AUS device these are: early or initial (persistent) UI, and delayed (recurrent) UI. There are many causes of persistent and/or recurrent UI and these can sometimes overlap. The potential causes include improper and/or accidental operation of the pump‐control unit, overactive bladder, cuff atrophy, cuff erosion, improper cuff size and pressure‐regulating balloon unit, as well as device malfunctions. The diagnostic evaluation in men with persistent and/or recurrent UI after AUS implantation requires sufficient understanding of the AUS mechanics and is a step‐wise and logical process with careful history and thorough clinical evaluation. Once a diagnosis is made, patients should be counselled and appropriate treatment instituted.

Adjustable versus non-adjustable male sling for post-prostatectomy urinary incontinence: A prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months

To review the patient choice, clinical outcomes and satisfaction rate between adjustable and non‐adjustable male sling (MS) with a minimum follow up of 24 months.

Can artificial urinary sphincter be an effective salvage option in women following failed anti-incontinence surgery?

Introduction and hypothesisThe role of artificial urinary sphincter (AUS) as salvage option following failed anti-incontinence surgery is unclear.MethodsDatabase review and telephone survey were conducted to review patient satisfaction, surgical outcomes, device failure and revision rates.ResultsA total of 29 female patients received AUS following failed anti-incontinence surgeries. Five (17%) AUS devices were explanted due to AUS erosion or infection. Thirteen AUS revisions were made and device malfunction accounted for 95% of the cases. Kaplan–Meier analysis showed more than 90% of AUS malfunction occurred less than 100xa0months from the time of implant. There was a significant decrease in pad use (3.6 to 0.2 pads per day; pu2009<u20090.01). The continence rate with no pad use was 70% and this increases to 83% in patients wearing one precautionary pad.ConclusionAUS is a safe, durable and effective salvage option for females with previous failed anti-incontinent surgeries.