Multicenter Analysis of Long-Term Outcomes of Artificial Urinary Sphincter Surgery After Urethroplasty

Abstract

Purpose: The artificial urinary sphincter (AUS) is the gold standard for male stress urinary incontinence. There is limited and conflicting evidence examining outcomes in AUS insertion after urethroplasty, particularly whether and how urethroplasty techniques affect them. We evaluated complications of AUS insertion after urethroplasty in a multi-institutional cohort. We hypothesize that complications occur at higher rates and vary between transecting and nontransecting urethroplasty.

Materials and methods: We retrospectively reviewed patients who underwent AUS after urethroplasty at 15 institutions. Demographic and clinical variables were analyzed. Urethroplasties were categorized as transecting or nontransecting. Long-term complications included AUS infection, erosion, and mechanical failure.

Results: One hundred seventy-eight cases were identified performed by 17 surgeons (range 4-40) from 15 institutions with a median follow-up of 33.5 (IQR 46) months. AUS complications requiring explantation, including infection, erosion, and mechanical failure after transecting urethroplasty, occurred in 56.2% compared with 23.5% after nontransecting urethroplasty (P < .001). Transecting urethroplasty technique was correlated with increased risk of device explant both from erosion (P = .004) and atrophy (P = .008). Radiation (HR, 0.46, 95% CI: 0.28-0.76, P = .002), hypertension (HR, 0.44, 95% CI: 0.27-0.73, P = .0008), and patient age (>68; HR, 0.5, 95% CI: 0.3-0.81, P = .004) also correlated to risk of device explantation.

Conclusions: Risk of experiencing AUS complications is higher in patients with transecting urethroplasty compared with the nontransecting group. Nontransecting urethroplasty may be advisable if a subsequent need for AUS is anticipated.

Keywords: artificial urinary sphincter; stress urinary incontinence; urethral sphincter; urethral stricture.