Urology · 2025
Time Dependent Material Fatigue of the Artificial Urinary Sphincter Pressure-regulating Balloon: A Mechanical and Microscopic Analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Salvino Matthew J, Schroeder Thomas E, Grimaud Logan W, Peterson Andrew C
Аннотация
OBJECTIVE: To assesses the influence of artificial urinary sphincter (AUS) device age on pressure-regulating balloon (PRB) mechanical and microscopic properties. The AUS is a fluid-filled hydraulic system comprised of a urethral cuff, mechanical pump, and PRB. Material fatigue prior to terminal failure of the PRB can reduce its ability to pressurize the urethral cuff, leading to recurrent urinary incontinence.
METHODS: Tensile testing was performed on PRBs from 32 previously implanted and 1 new AUS. Stress softening and relaxation testing, as well as scanning electron microscopy (SEM), were conducted on a subset of 7 PRBs evenly distributed in age. Data were analyzed using linear regression, Pearson correlation, and repeated measures ANOVA.
RESULTS: AUS device age ranged from 2 months to 17.6 years (median 7.2 years). There was a moderate positive linear correlation between PRB age and stiffness (r = 0.68, P <.01). PRB wall thickness displayed a weak negative correlation with PRB age (r = -0.38,P = .03). There was no noticeable weakening of the PRB with repeated use over the course of a day, regardless of the time of testing or device age. After SEM, 4 of the 7 PRB specimens revealed fine surface cracks present in their microstructure, which were evident in the 4 oldest specimens.
CONCLUSION: PRBs exhibit progressive material degradation with age prior to terminal failure, including increased stiffness, decreased wall thickness, and formation of microstructural defects. These findings underscore considering age-related PRB fatigue as a potential cause of declining device performance and support earlier evaluation of PRB replacement in symptomatic patients with recurrent stress urinary incontinence.
METHODS: Tensile testing was performed on PRBs from 32 previously implanted and 1 new AUS. Stress softening and relaxation testing, as well as scanning electron microscopy (SEM), were conducted on a subset of 7 PRBs evenly distributed in age. Data were analyzed using linear regression, Pearson correlation, and repeated measures ANOVA.
RESULTS: AUS device age ranged from 2 months to 17.6 years (median 7.2 years). There was a moderate positive linear correlation between PRB age and stiffness (r = 0.68, P <.01). PRB wall thickness displayed a weak negative correlation with PRB age (r = -0.38,P = .03). There was no noticeable weakening of the PRB with repeated use over the course of a day, regardless of the time of testing or device age. After SEM, 4 of the 7 PRB specimens revealed fine surface cracks present in their microstructure, which were evident in the 4 oldest specimens.
CONCLUSION: PRBs exhibit progressive material degradation with age prior to terminal failure, including increased stiffness, decreased wall thickness, and formation of microstructural defects. These findings underscore considering age-related PRB fatigue as a potential cause of declining device performance and support earlier evaluation of PRB replacement in symptomatic patients with recurrent stress urinary incontinence.