Does the Kaufman prosthesis still have a place? Review of thirteen years' experience

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.

The development and evolution of artificial urethral sphincters

This history and evolution of mechanical devices designed to achieve urinary continence are reviewed. The following devices were studies: Foley clamp, Kaufman prosthesis, Giori, Summers and Rosen sphincters, Gruneberger and Cleveland Clinic magnetic designs, Craggs sphincter and the AMS family of sphincters (AMS 721, AMS 761, AMS 742 (A, B, C), AMS 792, AMS 800). The design of active hydraulic devices is discussed in more detail. This review analyses the problems relating to the application of pressure and the presence of foreign material around the urethra. 'Volume set' devices are universally unsuccessful and detrimental for urethral integrity as opposed to 'pressure set' hydraulic sphincters (e.g. AMS 800). The implications for the design of artificial implants are discussed.

Orthoses and prostheses

Orthoses and prostheses include a wide range of devices and strategies for correcting and alleviating dysfunction and disability. Features in these areas of technology include continuing evolution of new devices, further development of well-established approaches, a need for critical assessment, requirements for support from technical and health care workers, and the need to identify funding to achieve efficient programs.