{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:49:50Z","timestamp":1792655390274,"version":"4.5.0"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,10,12]],"date-time":"2015-10-12T00:00:00Z","timestamp":1444608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To investigate the concept of \u2018urethral atrophy\u2019, which is often cited as a cause of recurrent incontinence after initially successful implantation of an artificial urinary sphincter (\n                      <jats:styled-content style=\"fixed-case\">AUS<\/jats:styled-content>\n                      ); and to investigate the specific cause of the malfunction of the\n                      <jats:styled-content style=\"fixed-case\">AUS<\/jats:styled-content>\n                      in these patients and address their management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>\n                      Between January 2006 and May 2013, 50 consecutive patients (mean age 54.3 years) with recurrent incontinence had their\n                      <jats:styled-content style=\"fixed-case\">AUS<\/jats:styled-content>\n                      explored for malfunction and replaced with a new device with components of exactly the same size, unless there was a particular reason to use something different. Average time to replacement of the device was 10.1 years. The mean follow\u2010up after replacement of the device was 24.7 months. All patients without an obvious cause for their recurrent incontinence had preoperative urodynamic evaluation, including measurement of the Valsalva leak point pressure (\n                      <jats:styled-content style=\"fixed-case\">VLPP<\/jats:styled-content>\n                      ) and the retrograde cuff occlusion pressure (\n                      <jats:styled-content style=\"fixed-case\">RCOP<\/jats:styled-content>\n                      ). After explantation of the\n                      <jats:styled-content style=\"fixed-case\">AUS<\/jats:styled-content>\n                      in patients without any apparent abnormality of the device at the time of replacement, the pressure generated by the explanted pressure\u2010regulating balloon (\n                      <jats:styled-content style=\"fixed-case\">PRB<\/jats:styled-content>\n                      ) was measured manometrically, when this was possible. In a select group of six consecutive patients of this type, the fibrous capsule surrounding the old cuff was incised then excised to expose and evaluate the underlying corpus spongiosum.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 31 of the 50 patients (62%) undergoing exploration, a specific cause for the malfunction of their\n                      <jats:styled-content style=\"fixed-case\">AUS<\/jats:styled-content>\n                      was defined. In the other 19 patients (38%) no cause was found, either preoperatively or at the time of exploration, other than a low\n                      <jats:styled-content style=\"fixed-case\">VLPP<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">RCOP<\/jats:styled-content>\n                      . A typical \u2018waisted\u2019 or \u2018hour\u2010glass\u2019 appearance of the underlying corpus spongiosum was demonstrable, to some degree, on explanting the cuff in all cases. In the six patients in whom the restrictive sheath surrounding the cuff was excised, the urethral circumference immediately returned to normal after the compressive effect of the sheath was released. Manometry of the explanted\n                      <jats:styled-content style=\"fixed-case\">PRB<\/jats:styled-content>\n                      s, when this was possible, showed a loss of pressure in all instances. Replacement of the explanted\n                      <jats:styled-content style=\"fixed-case\">AUS<\/jats:styled-content>\n                      with a new device with the same size cuff and\n                      <jats:styled-content style=\"fixed-case\">PRB<\/jats:styled-content>\n                      in 14 of these 19 patients was successful in 12 (85.7%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      These results, and other theoretical considerations, suggest that recurrent incontinence, years after initially successful implantation of an\n                      <jats:styled-content style=\"fixed-case\">AUS<\/jats:styled-content>\n                      , is because of material failure of the\n                      <jats:styled-content style=\"fixed-case\">PRB<\/jats:styled-content>\n                      , probably attributable to its age and consequent loss of its ability to generate the pressure it was designed to produce, and that urethral atrophy does not occur. Simply replacing the old device with a new one with the same characteristics, unless there is a particular reason to do otherwise, is usually successful and avoids the complications of alternatives such as as cuff downsizing, implanting a\n                      <jats:styled-content style=\"fixed-case\">PRB<\/jats:styled-content>\n                      with a higher pressure range, implantation of a second cuff or transcorporeal cuff placement, all of which have been advocated in these patients.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.13324","type":"journal-article","created":{"date-parts":[[2015,9,19]],"date-time":"2015-09-19T07:04:14Z","timestamp":1442646254000},"page":"669-676","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Urethral atrophy after implantation of an artificial urinary sphincter: fact or fiction?"],"prefix":"10.1111","volume":"117","author":[{"given":"Simon","family":"Bugeja","sequence":"first","affiliation":[{"name":"Reconstructive Urology Unit University College London Hospitals London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella L.","family":"Ivaz","sequence":"additional","affiliation":[{"name":"Reconstructive Urology Unit University College London Hospitals London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Frost","sequence":"additional","affiliation":[{"name":"Reconstructive Urology Unit University College London Hospitals London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela E.","family":"Andrich","sequence":"additional","affiliation":[{"name":"Reconstructive Urology Unit University College London Hospitals London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony 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