Decline in artificial urinary sphincter survival in modern practice-do we treat a different patient?

Over the past few years, we have been doing an increasing number of revisions for artificial urinary sphincters (AUS) at our center. The study aims to investigate reason for this change in our practice.

Demographics and surgical outcomes of patients who received AUS in 2003-2014 at our center were retrospectively evaluated, and patients were contacted to check the current status of their AUS. The outcomes of the study were: percentage of revisions and explanation, survival, and the risk factors associated with these events.

A total of 102 patients (72 years (30-87)) underwent 214 procedures: 99 primary implants, 11 secondary implants, 84 revisions, and 20 explantations-median follow-up was 54 months (5-146). The 5-years and 10-years revision-free survival for AUS were 47% and 23%, respectively. The 5 and 10 years explantation-free survival were 77% and 72%, respectively. The median time to revision for AUS implanted in 2010-2014 was shorter than in AUS implanted in 2003-2009 (6 vs. 13.5 months, P = 0.08). The percentage of AUS that were preceded by urethral surgery for incontinence was significantly higher in AUS implanted in 2010-2014 than in those implanted in 2003-2009 (19% vs. 63%, P = 0.001). The percentage of patients with AUS who received radiotherapy in the past 5 years was higher than in 2003-2009 (53% vs. 30%, P = 0.09).

In modern urological practice, more exposure to RT and previous surgeries for incontinence are associated with increased risk for revision with decline in AUS survival.