Prevalence and Risk Factors of Artificial Urinary Sphincter Revision in Non-Neurological Male Patients.

To assess the prevalence and risk factors of male AUS mechanical failures and non-mechanical failures.

The charts of all male patients who underwent AUS implantation between 2004 and 2020 in 16 centres were retrospectively reviewed. Patients with neurogenic stress urinary incontinence (SUI) were excluded as well as revisions/explantations due to infections and/or erosions. The causes of revision were divided into mechanical failures (fluid loss or malfunction from any components of the AUS), non-mechanical failures (urethral atrophy, recurrence/persistence of SUI despite normally functioning device) and other (pump malposition, balloon herniation, hematoma, pain). Failure-free survival analysis was performed both for general and specific causes of revision. Predictors of mechanical and non-mechanical failures were determined by Cox proportional hazards model.

1020 patients met the inclusion criteria. After a median follow-up of 20 months, the estimated 5-year and 10-year overall revision free survival were 60% and 40%. There were 214 AUS revisions: 59 (27.6%) for mechanical failures, 121 (56.5%) for non-mechanical failures and 34 (15.9%) other causes of revision. In multivariable Cox regression analysis, larger cuff size was the only predictor of overall revisions (HR=1.04 [1.01 - 1.07]; p=0.01) and revision for non-mechanical failure (HR=1.05 [1.02 - 1.09]; p=0.004).

Half of the male AUS patients undergo device revision within the first ten years after implantation. Non-mechanical failures are the primary cause of AUS revision in non-neurological men. Larger cuff size appears to be the main determinant of AUS revision's risk.

The Journal of urology. 2021 Jun 29 [Epub ahead of print]

Imad Bentellis, Mehdi El-Akri, Jean-Nicolas Cornu, Thibaut Brierre, Tiffany Cousin, Victor Gaillard, Hugo Dupuis, Thibault Tricard, Nicolas Hermieu, Priscilla Bertrand-Leon, Daniel Chevallier, Franck Bruyere, Xavier Biardeau, Jean-Francois Hermieu, Pierre Lecoanet, Grégoire Capon, Xavier Game, Christian Saussine, Mathieu Durand, Benoit Peyronnet

Department of Urology, University of Rennes, Rennes, France., Department of Urology, University of Nice, Nice, France., Department of Urology, University of Rouen, Rouen, France., Department of Urology, University of Toulouse, Toulouse, France., Department of Urology, University of Bordeaux, Bordeaux, France., Department of Urology, University of Strasbourg, Strasbourg, France., Department of Urology, Bichat Hospital, Paris, France., Department of Urology, University of Reims, Reims, France., Department of Urology, University of Tours, Tours, France., Department of Urology, University of Lille, Lille, France., Department of Urology, University of Nancy, Nancy, France.

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