Delayed Removal of the Noninfected Artificial Urinary Sphincter Has Comparable Outcomes to Immediate Removal

To compare the clinical outcomes of immediate removal (IR) vs delayed removal (DR) of a patients presenting with eroded, clinically noninfected artificial urinary sphincters (AUS).

We examined our prospectively maintained AUS quality improvement database from 2009 to 2024. Patients without clinical signs of infection were included. Patients with suspected infection defined by SIRS criteria and/or infectious symptoms (fever >101.5 °F, scrotal erythema/swelling, purulence, or extrusion) were excluded. Patients were stratified by time of diagnosis to removal, IR defined as <24 hours from diagnosis or same calendar day, and DR defined as >24 hours from diagnosis or at least next calendar day. Complication rate after explantation (persistent extravasation, urethral stricture, urethrocutaneous fistula, scrotal abscess/cellulitis, and pubic osteomyelitis) was compared between groups.

53 explantations of 110 erosions met inclusion criteria (IR, n = 15; DR, n = 38). Median device age at erosion was 17 months (IQR 8-94) in the IR group and 10.5 months (4-47.5) in the DR group. Median time of diagnosis to AUS removal was 0 days (IQR 0-1) and 4 days (IQR 2-5.3) for IR and DR groups, respectively. At a median follow-up of 353 days (IQR 103.5-1361.5), there was no significant difference between IR and DR groups in the presence of complications in patients (33% and 42% respectively, P = .782).

Despite the traditional teaching that immediate removal is necessary for all AUS erosions, the outcomes of immediate and delayed removal of clinically noninfected, eroded AUS devices are not statistically different and likely have comparable outcomes.