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Survival of the artificial urinary sphincter in a changing patient profile

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Abstract

Purpose

To examine the functional survival of the artificial urinary sphincter (AUS) AMS800 in a changing patient population. Because of increasing experience and dexterity of the operating team, we hypothesize that patients with known risk factors nowadays have a better survival of their prosthesis. However, due to a change to a more complex case mix, overall results appear to be worse.

Materials and methods

All men who underwent implantation of an AUS between 2001 and 2016 because of urethral sphincter deficiency were retrospectively analyzed. Patients were divided in groups based on date of surgery and number of patients: 2001–2009 (G1), 2010–2013 (G2), 2014–2016 (G3). Baseline characteristics and additional therapies prior to implantation were analyzed in all groups. Risk factors for failure only in G1 and G2. Revision or explantation of the AUS was used as endpoint. Kaplan–Meier analysis was used to calculate survival of the device.

Results

A total of 129 patients (mean age 72 ± 9 years) underwent 129 primary implants, and 11 secondary implants. Median follow-up was 5.74 years in G1, 3.26 years G2 and 1.54 years G3. Approximately 25% of the patients in G1 had received adjuvant therapy for prostate cancer and 14% underwent previous surgery for incontinence. In G2, 51 and 55% underwent adjuvant therapy for prostate cancer and previous surgery for incontinence, respectively, G3 was comparable. The overall 50% survival improved in patients with radiotherapy and previous incontinence surgery in G2 as compared to G1.

Conclusions

Despite the more complex patient population, the survival of the AUS did not decrease. In some patient categories, the AUS functional survival is even still improving over the past few years.

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Authors and Affiliations

  1. Radboud University Medical Center, Nijmegen, The Netherlands

    M. J. te Dorsthorst, M. J. van der Doelen, F. Farag, F. M. J. Martens & J. P. F. A. Heesakkers

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  1. M. J. te Dorsthorst
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  2. M. J. van der Doelen
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  3. F. Farag
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  4. F. M. J. Martens
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  5. J. P. F. A. Heesakkers
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Contributions

MJD data collection or management, data analysis, manuscript writing/editing. MJD manuscript writing/editing, data analysis. FF data collection or management. FMJM manuscript writing/editing. JPFAH protocol/project development.

Corresponding author

Correspondence to M. J. te Dorsthorst.

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Conflict of interest

None declared.

Research involving human participants and/or animals

The study was approved by the ethical committee of RadboudUMC.

Informed consent

Informed consent was obtained from all patients.

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te Dorsthorst, M.J., van der Doelen, M.J., Farag, F. et al. Survival of the artificial urinary sphincter in a changing patient profile. World J Urol 37, 899–906 (2019). https://doi.org/10.1007/s00345-018-2448-7

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  • DOI: https://doi.org/10.1007/s00345-018-2448-7

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