Related Experiment Video
Updated: Jan 9, 2026
Transcorporal Artificial Urinary Sphincter Cuff Placement in a Case Requiring Revision for Urethral Atrophy
Published on: June 16, 2022
Salvage Artificial Urinary Sphincter Placement After Sling Failure: Long-term Outcomes and Institutional Predictors
Behzad Abbasi1, Nizar Hakam1, Mikołaj Frankiewicz2
1Department of Urology, University of California San Francisco, San Francisco, CA.
Objectives:
To characterize transitions from sling to artificial urinary sphincter (AUS) and identify contributing factors.
Methods:
We analyzed longitudinal ambulatory surgery records from California's Department of Health Care Access and Information (2007-2016). Adult male California residents who underwent index AUS or sling placement were identified. Primary outcome was time to transition from sling to AUS. A multivariable Cox proportional hazards model was used to identify factors associated with salvage AUS placement among sling patients. Another univariable model compared the long-term AUS failure risk in salvage versus primary AUS recipients.
Results:
Our cohort comprised 1,400 sling patients from 154 facilities, with a median follow-up of 3.7 years (IQR, 1.3-5.2 years). At eight years, 20% of sling recipients required salvage AUS. In the multivariable model, a facility's higher annual AUS caseload (aHR 1.59, 95% CI 1.01-2.49) and greater patient travel distance (aHR 1.19 per 50-mile increase, 95% CI 1.00-1.40) were associated with increased likelihood of salvage AUS placement. Conversely, a high sling volume at the index center was associated with a reduced risk (aHR 0.57, 95% CI 0.38-0.84). Salvage AUS showed durability comparable to that of primary AUS (HR 0.79, 95% CI 0.55-1.13).
Conclusions:
One in five sling recipients ultimately requires salvage AUS. Salvage AUS had a similar success rate to that of primary AUS. Institutional experience and geographic access influence reoperation trajectories, underscoring the importance of careful patient selection and counseling.
