Third Artificial Urinary Sphincter Cuff Placement Following Two Failures in Males: A Real-World Multicenter Study

Area of Science:

• Urology
• Medical Devices
• Surgical Outcomes

Background:

• Artificial urinary sphincters (AUS) have a 25% reoperation rate.
• Outcomes after second AUS are scarce; data on third AUS implants are non-existent.
• Reimplantation after erosion or infection leads to poorer survival rates.

Purpose of the Study:

• To evaluate functional and survival outcomes of a third artificial urinary sphincter (AUS) following two previous explantations.
• To identify predictive factors for reoperation and functional success.
• To assess the long-term viability of multiple AUS reimplantations.

Main Methods:

• Retrospective review of 75 patients receiving a third AUS between 2006-2023 across seven French university hospitals.
• Inclusion criteria: third AUS implant after two previous cuff explantations or revisions.
• Primary endpoint: reoperation-free survival; secondary endpoints: functional outcomes at 6 months and last follow-up.

Main Results:

• 5-year reoperation-free survival was 34.8%. Smoking was the only significant predictor of explantation.
• Early complications occurred in 16.7% of patients.
• At last overall follow-up, 54.8% achieved social continence, but 35.6% failed, with 30.7% needing a fourth or fifth AUS.

Conclusions:

• Third AUS implantation shows comparable early function to primary implants but inferior survival and late functional outcomes.
• Patient-related factors, not surgical technique, predict outcomes.
• A third AUS may be considered for highly motivated patients with limited alternatives, necessitating refined patient selection criteria.