Addition of a Second Urethral Cuff to Enhance Performance of the Artificial Urinary Sphincter

PURPOSE: Stress urinary incontinence may persist in approximately 15% of men following implantation of a standard artificial urinary sphincter. The ability of a second urethral cuff to provide satisfactory continence without additional operative complications was investigated. MATERIALS AND METHODS: A second urethral cuff was placed to enhance performance of the artificial urinary sphincter in 5 men with stress urinary incontinence following radical prostatectomy. A stainless steel 3-way tubing connector allowed for addition of a second cuff to the standard artificial urinary sphincter without the kinking problems previously observed with a flexible 3-way connector. In 4 consecutive men a second cuff was added at operative revision of an existing artificial urinary sphincter that had failed to produce satisfactory continence. A double cuff artificial sphincter was placed initially in 1 man. RESULTS: Of 5 men 4 had satisfactory and 1 had improved continence with the double cuff artificial urinary sphincter. The stainless steel 3-way tubing connector eliminated kinking complications. CONCLUSIONS: Implantation of a second urethral cuff can provide satisfactory urinary continence in men with an artificial urinary sphincter and persistent incontinence. Placement of a double cuff artificial urinary sphincter may also represent appropriate initial intervention in men with significant stress urinary incontinence.