A review of the complications and results of implantation of the AMS artificial urinary sphincter

The history and evolution of devices designed to achieve urinary continence are reviewed. Passive and active (including volume and pressure regulated) devices are described in detail. Meta-analysis of the published studies revealed that continence improved in 88% of patients and total continence was achieved in 73%. Global revision rate was 32%. Urethral erosion occurred in approximately 12%, infection in 4.5% and mechanical complications in 14% of cases. The complications relating to the AMS artificial urinary sphincter are analyzed. The majority of patients (> 85%) required only one revision. 22% of complications were due to mechanical malfunction. Infection comprised 12.9% of complications. The patterns of total revisions followed a double exponential decay curve: 50% of revisions were performed within 8 months and 90% within 3 years of implantation. Complications were still reported several years postimplantation. This review analyzes the problems relating to the application of pressure and the presence of foreign material around the urethra and exemplifies the requirement for long-term specialist follow-up of these patients.