ABSTRACT
The artificial urinary sphincter (AUS) remains an alternative to slings or periurethral injection therapy in the management of urinary incontinence, especially when the aforementioned interventions have failed. The aus has been most often used for treatment of incontinence due to primary urethral sphincter deficiency (type iii stress urinary incontinence [SUI], or intrinsic sphincter deficiency [ISD] [1–3]). Isd may be the result of periurethral fibrosis from prior anti-incontinence procedures, neurological disorders (spinal cord injury, peripheral neuropathy), radical pelvic operations, pelvic radiation therapy, or the effects of aging and estrogen deficiency on the urethra and anterior vaginal wall. These conditions affect the ability of the urethra wall elements to coapt, thereby producing a poorly functional sphincteric mechanism. The pubovaginal sling is considered the gold standard for the treatment of isd, yet some patients will have less than adequate results despite several attempts [4]. The aus enhances higher intraurethral pressures by increasing pressure circumferentially around the urethra, lessening the transmission of intra-abdominal pressures. Therefore, in some cases, the aus may benefit women with urethral weakness and good anterior vaginal wall who have sphincteric dysfunction.
