Revision of the artificial urinary sphincter in men: a long-term experience from a single centre

Introduction. Implantation of an artificial urinary sphincter (AUS) is the main treatment method of surgical treatment in men with moderate to severe stress urinary incontinence. Despite its efficacy, implantation is sometimes accompanied by the development of complications, which in some cases necessitate revisions and removal of the entire device or its components. Objective . To evaluate the outcomes of AUS implantation regarding safety and the need for re-interventions at long-term follow-up. Materials & methods . From 2004 to 2023, AUS was implanted in 62 patients with severe stress urinary incontinence. Complications are described according to the Clavien-Dindo classification. Revisions followed replacement of components or the entire AUS in the absence of signs of infection and revisions followed components or entire AUS explanation in case of infection were registered. Results . The mean patient age at the time of implantation was 67.4±8years. With amedian follow-up time of 73.5months (IQR 14.8 – 118.3 months), complications were noted in 22 (35.5%) patients, and 33 revisions were performed. The median time to complication requiring replacement of the AUS or its components was 60 months (IQR 50 – 94 months). The median time to complication requiring removal of the AUS or its components was 31 months (IQR 8 – 83 months). A statistically significant effect of type 2diabetes mellitus on AUS component replacement was revealed (OR 4.9, p<0.05). Conclusions . AUS implantation is associated with the development of complications that necessitate revision. These complications account for roughly one-third of all AUS interventions. Revision operations contribute to restoring AUS functionality and enhancing patients' quality of life. Given the inadequacy of applying the general surgical classification of complications to men undergoing surgical treatment for urinary incontinence, there is a need to modify the documentation and classification of such complications.