Editing AUA: Incontinence after Prostate Therapy (2019) (section)

====== Complications ======
* '''<span style="color:#ff0000">Intraoperative urethral injury</span>'''
** '''<span style="color:#ff0000">If identified during implantation, procedure should be abandoned and subsequent implantation should be delayed</span>'''
* '''<span style="color:#ff0000">Persistent leakage</span>'''
* '''<span style="color:#ff0000">Cuff erosion</span>'''
** Can be due to unrecognized urethral injury at the time of initial surgery or more likely due to subsequent instrumentation of the urethra including catheterization.
** '''Management:'''
*** '''AUS explant with the urethral catheter left in place for a few weeks to allow the urethral defect to heal'''
*** '''AUS should not be re-implanted until at least 3 months'''
* '''<span style="color:#ff0000">Infection</span>'''
** '''<span style="color:#ff0000">Device infection occurs in <1-5% of cases'''
** '''<span style="color:#ff0000">Diagnosis and Evaluation'''
***'''<span style="color:#ff0000">History and Physical Exam'''
****'''<span style="color:#ff0000">Presents with (4):'''
****#'''<span style="color:#ff0000">Pain at the site of the AUS'''
****#'''<span style="color:#ff0000">Fever'''
****#'''<span style="color:#ff0000">Scrotal warmth or erythema'''
****#'''<span style="color:#ff0000">Skin changes'''
** '''<span style="color:#ff0000">Management:'''
*** '''<span style="color:#ff0000">Urgent AUS explantation'''
*** '''AUS should not be reimplanted until at least 3 months''' to allow the infection to clear and inflammation to subside.
* '''<span style="color:#ff0000">Mechanical failure</span>'''
*'''<span style="color:#ff0000">Decreased efficacy over time and reoperations are common</span>'''
** '''The current version consists of''' a hydraulic system composed of '''3 separate parts:'''
**# '''A urethral cuff''' of varying sizes
**# '''A pressure regulating balloon reservoir''' with three available pressure profiles
**# '''A control pump'''
*** The device will fail if any of the 3 parts, the tubing, or connections suffer a micro-perforation with loss of fluid
** The rate of device failure increases with time, with '''failure rates of'''
*** '''≈24% at 5 years'''
*** '''≈ 50% at 10 years'''
** '''AUS might need to be replaced over time due to persistent or recurrent incontinence generally due to (3):'''
**# '''Urethral atrophy'''
**# '''Improper cuff sizing'''
**# '''Partial fluid loss'''