Artificial Urinary Sphincter Revision with Pump Preservation: A Prospective Feasibility Study

To evaluate the feasibility and safety of preserving a normally functioning pump during AUS revision surgery.

Following institutional review board approval, we prospectively evaluated consecutive patients undergoing AUS revision for mechanical or non-mechanical failure at a single tertiary referral center between 2023 and the present. Demographic, operative, and postoperative outcomes were collected.

Sixty AUS revisions were analyzed. Median time from primary implantation to revision was 8.6 years (IQR 3.9-13.1). Most revision procedures were performed for cuff-related mechanical failure (65%). A normally functioning pump was preserved in all patients. Median operative time was 43 minutes (IQR 33-51), and all procedures were performed on an outpatient basis. Devices were reactivated after a median of 2 weeks compared with our standard 6-week activation following pump replacement. No pump-related complications, including hematoma, pain, or malposition, were observed. No patient required reoperation for pump malfunction, and no pump-specific mechanical failures occurred.

Pump-specific mechanical failure is uncommon. Among 1,327 AUS revision procedures in our institutional database (3,144 total AUS procedures), only 11 (0.82%) were attributable to pump malfunction. In appropriately selected patients with a normally functioning pump, preservation of the existing pump appears feasible and safe while avoiding unnecessary scrotal dissection, permitting earlier device activation, and potentially reducing postoperative morbidity. Longer-term follow-up is needed to confirm the durability of this selective revision strategy.