Analysis of device survival and predictive factors of failure in a cohort of patients with male artificial urinary sphincter

Introduction

Stress urinary incontinence (SUI) affects between 2.5% and 40% of patients after radical prostatectomy. Although the implantation of an artificial urinary sphincter (AUS) offers continence rates of 70%–80%, its failure rate reaches 25% in some series. This single-center retrospective study analyzed the survival of AUS and the factors associated with its failure.

Materials and methods

A total of 145 patients treated with the AMS 800 device (Boston Scientific®) between 2010 and 2023 were included. Kaplan-Meier analysis and the Cox proportional hazards model were used to evaluate device survival and identify predictive factors for failure.

Results

The mean age was 68.6 years; 28% of patients were smokers, 43.7% had diabetes, and 26.2% had undergone prior radiation therapy. Radical prostatectomy was the main cause of SUI (86.9%). In the majority of cases (91.5%), the artificial urinary sphincter was implanted around the bulbar urethra. During follow-up, 25.5% of patients required revision surgery. The probability of functional sphincter survival was 89% at 1 year, 78% at 2 years, 64% at 5 years, and 51% at 10 years. On multivariate analysis, prior radiation therapy [HR 2.06; P = .029] and diabetes [HR 2.24; P = .04] were associated with poorer device survival.

Conclusions

The AUS is an effective and safe treatment for severe SUI, although radiotherapy and diabetes may adversely affect its durability.