Surgical management of recurrent stress urinary incontinence due to urethral atrophy utilizing the mature cuff pseudocapsule.

OBJECTIVE: To describe a novel artificial urinary sphincter (AUS) revision technique for treating recurrent stress urinary incontinence (SUI) caused by urethral atrophy by utilizing the mature cuff pseudocapsule to restore urethral bulk, while minimizing perineal dissection and corporal involvement. METHODS: Patients with urethral atrophy and recurrent SUI who underwent AUS revision between September 2005 and March 2025 were retrospectively reviewed. All patients underwent cuff removal and reimplantation utilizing the existing bulbourethral pseudocapsule. Demographic, clinical, continence, and complication data were collected. Patients with incomplete records or follow-up <12 months were excluded. RESULTS: Twenty-nine patients met inclusion criteria. Mean age at initial AUS placement was 67.1 years (range 49-76). Median original cuff size was 4.0cm (range 3.5-5.0). Before revision, average daily pad use and weight were 4.5 (range 2-8) and 423g (range 130-990). Mean time to revision was 5.1 years (range 2.3-13.8). Median replacement cuff size was 4.5cm (range 4.0-5.0). At mean follow-up of 42.0 months (range 12-116), average daily pad use and weight decreased to 0.9 (range 0-2) and 29g (range 0-147) (p < 0.05). Two men underwent explantation for infection and two required AUS removal for cuff erosion following catheterization. CONCLUSIONS: AUS revision utilizing the original cuff pseudocapsule significantly reduced pad use and weight in patients with urethral atrophy. The technique restores urethral bulk, minimizes perineal dissection, avoids transcorporal placement, and represents a viable surgical option for recurrent SUI after AUS implantation.