Modifications in artificial urinary sphincter placement

Although the male sling procedure is becoming increasingly popular, the artificial urinary sphincter (AUS) remains the gold standard due to its favorable outcome, long-term durability, and ability to treat mild, moderate, and severe urinary incontinence caused by intrinsic sphincter deficiency. However, AUS mechanical failure and the small but predictable occurrence of infection, erosion, and sub-cuff atrophy make it imperative that prosthetic urologists be familiar with salvage techniques. Secondary techniques to manage common complications are Mulcahy AUS salvage for infection, Webster's transcorporal AUS cuff placement to prevent urethral erosion, and tandem cuff placement for urethral atrophy. Recent design modifications have introduced antibiotic-impregnated urinary sphincters that may decrease infections in primary and secondary AUS implants. Innovations in AUS placement, such as Mulcahy immediate AUS salvage and Webster's transcorporal cuff placement, have allowed restoration of continence in men who previously had conditions considered untreatable. © 2008 Springer Science+Business Media, LLC.