Urinary incontinence is a relatively common and potentially disabling disease affecting the life quality of a patient. Many successful series in the treatment of incontinence by medical or surgical therapy using autologous materials have been
reported.
However, those who have structural abnormalities, injury around the urethra, and derangements in the nervous system could not be benefited by such treatment. In other countries, the artificial urethral sphicter, introduced in 1972, have achieved
satisfactory results and then increased in use; but in Korea, it was not widely used because of many limitations and obstacles. Based on our ten-year experience with 10 cases of implantation of artificial urethral sphincter from 1987 to 1996, we
tried
to elucidate the present status, problems, and the possible ways of improvements of its use within this country.
A total of ten male patients underwent implantations of the AMS model 800 artificial urethral sphincter. Mean age was 34.5 (17-43) years. Mean follow-up was 4.2 (0.5-10) years. Two patients were spinal cord injury patients, 2 meningomyeloceles,
and
6
posterior urethral injuries. Two patients had the prosthesis removed due to infection and cuff erosion. In the other 8 patients, 6 were dry(75.0%) and 1 was improved (12.5%) and 1 was wet (12.5%). The revision rate was 20%(2/10) and overall
improvement
of incontinence was observed in 7 (87%) patients.
The reasons for the low incidence of the implantation of artificial urinary sphincter in this country are as follows. Accerding to the other reports, the most common application of artificial urinary sphincter in the west is in the
post-prostatectomy
incontinence accounting for about 40-60% of artificial urinary sphincter implantation whereas in this country, the majority of cases are patients who had trauma. Since radical prostagectomy has not been established well in the country(in the
recent
4
years, totally only 53 cases were performed) and also the excellent performance of the transurethral surgery making the incidence of incontinence low, could be one of the reasons. In addition, the high price of the prosthesis over 4 million won
and
operation fee of 3 to 6 million won is a formidable burden to most patients, In the view of mechanical problem, the cuff size of the urethra in the oriental people is observed smaller than the western, and we must let the company prepare the cuff
set of
smaller size.
In conclusion, if we solve those problems in our country, the artificial urethral sphincter is an effective device for treatment of urinary incotinence in patients who have failed more conservative modes of therapy.
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