Patterns and timing of artificial urinary sphincter failure.

Area of Science:

• Urology
• Medical Device Technology
• Health Services Research

Background:

• Urinary incontinence is a common complication following prostatectomy.
• Artificial urinary sphincters (AUS) are a treatment option for post-prostatectomy incontinence.
• Optimal timing for AUS placement after prostatectomy is not well-established.

Purpose of the Study:

• To evaluate trends in artificial urinary sphincter (AUS) placement post-prostatectomy.
• To determine how the timing of AUS implantation affects device survival and complication rates.

Main Methods:

• Analysis of SEER-Medicare data (2002-2011) for patients undergoing prostatectomy and AUS placement.
• Multivariable Cox proportional hazard models used to assess factors influencing reoperation time after AUS implantation and prostatectomy.

Main Results:

• 841 men received AUS, with a median of 23 months post-prostatectomy.
• Later AUS placement (>15 months) was associated with less need for reintervention initially.
• Radiation therapy and prior sling surgery were independent predictors of earlier reoperation.

Conclusions:

• Delayed AUS implantation in the Medicare population shows improved initial device survival.
• Radiation and prior sling surgery are key factors predicting earlier reoperation.
• Further research is needed to identify patient-specific factors influencing AUS timing decisions.