Third Artificial Urinary Sphincter Cuff Placement Following Two Failures in Males: A Real-World Multicenter Study.

Abstract

Introduction: The reoperation rate for artificial urinary sphincters (AUS) in men is about 25%, with poorer survival rates when reimplantation occurs after urethral erosion or infection. Data on the outcomes of second AUS implants are rare, and no data exist for third AUS implants. We aimed to evaluate the functional and survival outcomes of a third AUS after two previous explantations.

Methods: The records of all patients implanted with a third AUS between 2006 and 2023 in seven French university hospitals were reviewed retrospectively. Only AUS implants following two previous AUS cuff explantations or revisions were included. The primary endpoint was the reoperation-free survival of the third AUS. Secondary endpoints included functional outcomes at 6 months and at the last follow-up, and overall functional outcomes after possible subsequent AUS implants, as well as reoperations.

Results: A total of 75 patients were included. Early complications occurred in 16.7% of patients. Median follow-up was 11 months (1-122), 28 explantations were required (37.3%). The 5-year reoperation-free survival rate was 34.8%. The only significant predictive factor for explantation was smoking. At 6 months, 66.2% of patients were socially continent (0-1 protection per day), 10.8% were improved, and 23% were unchanged or worsened. At the last follow-up of the third AUS, these results were 40%, 5.3%, and 54.7%, respectively. However, at the last overall follow-up (median 12 months, 1-183), social continence was 54.8%, improvement 9.6%, and failure 35.6%, with 23 patients (30.7%) receiving a fourth or fifth AUS.

Conclusion: Early functional outcomes of a third AUS are similar to primary AUS, but survival rates and late functional outcomes are inferior. Predictive factors for outcomes were related to patients, not the surgery itself. A third AUS may be suitable for motivated patients with limited therapeutic options. Further studies are needed to refine patient selection and assess the impact of reimplantation techniques on outcomes.