Preface to “50 years anniversary of the modern artificial urinary sphincter”

Dr. Brantley Scott is acknowledged as the father of modern urinary prosthetic surgery and published his seminal paper on the first modern artificial urinary sphincter (AUS) in 1973, which later became the AMS 800^TM AUS device. Despite significant scientific advances in device technology, design and materials over the last 50 years, the principle of mechanism remains unchanged and is based on a hydraulics-based system with movement of saline between the urinary cuff, pressure regulating balloon and pump, to provide a constant occluding luminal pressure to the urinary channel (bulbar urethra or bladder neck) when continence is desired and to relieve the cuff pressure when the patient intends to void. To date, the AMS 800^TM device is considered the standard of care for males with stress urinary incontinence (SUI), especially in those with moderate to severe cases, radiation-induced SUI and as an effective salvage for a failed male sling (MS). While the AMS 800^TM device is effective, durable and safe in carefully selected cohorts when performed with strict adherence to safe surgical principles, it is not without its limitations and complications in some of the “high-risk” populations. Newer and novel AUS-like devices have been designed to overcome some of the current limitations of the AMS 800^TM device but are hampered by unknown long-term efficacy and safety data. Similarly, scientific advances in MS design and technology have led to a plethora of MS devices in the commercial market and can be considered an attractive alternative to the AMS 800^TM to treat mild to moderate SUI and in patients who do not want to operate a device to void. This unique collection of excellent review articles by world experts in the field of urinary prosthetic and reconstructive surgery in this special edition of “50 Years Anniversary of the Modern Artificial Urinary Sphincter” is aimed at highlighting some of the most critical and controversial areas in SUI surgery as well as exploring the newer and novel therapeutic options. Each of these articles has been authored by experts in the field who are in most cases themselves driving and transforming scientific research. It is a tremendous effort to bring together these experts to author these state-of-the-art reviews. I have enjoyed editing this collection and learned a lot from these excellent articles. I hope you will likewise find them helpful (and thought-provoking) in furthering your understanding of urinary prosthetics and reconstructive surgery for your clinical practice.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Translational Andrology and Urology, for the series “50 Years Anniversary of the Modern Artificial Urinary Sphincter”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2024-01/coif). The series “50 Years Anniversary of the Modern Artificial Urinary Sphincter” was commissioned by the editorial office without any funding or sponsorship. E.C. serves as an unpaid editorial board member of Translational Andrology and Urology from August 2018 to July 2026 and served as the unpaid Guest Editor of the series. He is the Chair of male LUTS section (pro bono) of Urological Society of Australia and New Zealand. He is also the Member of the Committee on Surgery for Male Incontinence (pro bono) of International Consultation on Incontinence. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Eric Chung