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Long-term outcomes and patient satisfaction after artificial urinary sphincter implantation

  • Original Article
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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate long-term functional outcomes of artificial urinary sphincter implantation in men for the treatment of stress urinary incontinence.

Materials and methods

Patients who underwent artificial urinary sphincter implant for non-neurogenic stress urinary incontinence between June 1989 and January 2020 were included in this single-centre retrospective series. All patients with a functional artificial urinary sphincter in situ were contacted to evaluate long-term functional outcomes using validated questionnaires.

Results

A total of 263 patients were included in this retrospective series with a mean follow-up of 61 months. Explant-free survival after 5 years was 75% with a median time to explant of 16.2 years. Revision-free implant survival was 62% after 5 years with a median revision-free implant survival rate of 10.8 years. Previous pelvic irradiation, history of stricture disease and previous artificial urinary sphincter implant were associated with decreased implant survival. Overall social continence rate after 5 years was 60%. Prior radiation therapy, anticoagulation therapy and previous anti-incontinence surgery were associated with a higher incontinence risk. On long-term evaluation of 158 patients with their artificial urinary sphincter currently in situ, 51% were socially continent and 29% reported they were totally dry. Of these patients, 92% indicated to be satisfied with their current continence status.

Conclusion

A significant proportion of patients undergoing artificial urinary sphincter implant incontinence needed revision or explant surgery. Long-term continence rates are acceptable but tend to decrease by time. Nonetheless, if patients can maintain a functional AUS in situ, long-term patient satisfaction rates remain high.

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Code availability

The data for this project are confidential, but may be obtained in agreement with the General Data Protection Regulation of the University Hospitals Leuven. Researchers interested in access to the data may contact the corresponding author. It can take some months to negotiate data use agreements and gain access to the data. The author will assist with any reasonable replication attempts for two years following publication.

Abbreviations

AUS:

Artificial urinary sphincter

PGII:

Patient Global Improvement Indices Score

UDS:

Urodynamic study

RCT:

Randomized controlled trial

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Acknowledgements

The authors want to thank Annouschka Laenen for her statistical advice.

Funding

The authors report they received no funding for this study.

Author information

Authors and Affiliations

Authors

Contributions

Study concept and design: CS, YD and FVDA. Acquisition of data: CS and YD. Analysis and interpretation of data: CS and YD. Drafting of the manuscript: CS and YD. Critical revision of the manuscript: EB, DDR and FVDA. Statistical analysis: CS, YD and FVDA.

Corresponding author

Correspondence to Frank Van der Aa.

Ethics declarations

Conflict of interest

C.S., Y.D. and E.B. have nothing to disclose. D.D.R. reports personal fees from Astellas and Apogepha, grants and personal fees from AMS, Allergan, Bard and Medtronic, outside of the submitted work. F.V.D.A. is a proctor and advisor for and has received travel grants from Boston Scientific and Coloplast.

Ethics approval

This study had been approved by the competent ethics committee and all applicable institutional and governmental regulations concerning the ethical use of the data were followed. All data were encrypted and kept confidential.

Availability of data and material

All data are available at the urology department of the University Hospitals, Leuven, Belgium.

Consent to participate

All patients that participated in de telephone questionnaire gave their explicit informed consent.

Consent for publication

All authors have given their consent for publication.

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Supplementary Information

Below is the link to the electronic supplementary material.

345_2021_3877_MOESM1_ESM.docx

Supplementary file1 Overview of patient charactistics, peroperative parameters and post-operative complications. (DOCX 18 KB)

Supplementary file2 Reasons for AUS explant B. Reasons for AUS revision/maintenance. (DOCX 14 KB)

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Deruyver, Y., Schillebeeckx, C., Beels, E. et al. Long-term outcomes and patient satisfaction after artificial urinary sphincter implantation. World J Urol 40, 497–503 (2022). https://doi.org/10.1007/s00345-021-03877-1

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  • DOI: https://doi.org/10.1007/s00345-021-03877-1

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