Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2026 Feb;215(2):203-212.
doi: 10.1097/JU.0000000000004794. Epub 2025 Sep 29.

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

Meghan F Davis  1   2 , Dmitriy Nikolavsky  3 , Andre G Cavalcanti  4 , Brian J Flynn  5 , Reynaldo G Gomez  6 , Jeff Loh-Doyle  7 , Stuart D Boyd  7 , Akio Horiguchi  8   9 , Matthias D Hofer  10 , Margit Fisch  11 , Roland Dahlem  11 , Francisco E Martins  12 , Felix Campos-Juanatey  13   14   15 , Paul J Rusilko  16 , Henriette Veiby Holm  17 , Jay Simhan  18 , Javier C Angulo  19 , Tim A Ludwig  11 , Jose O Bernal  20 , Margaret Higgins  5 , Sasha Vereecken  5 , Josh Sterling  3 , Erin K Hays  1   2 , Peter G Kolyvas  21 , Alexander Stanisic  22 , Juan F Dorado  23 , Krishnan Venkatesan  1   2   24
Affiliations
Multicenter Study

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

Meghan F Davis et al. J Urol. 2026 Feb.

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose.

Figures

Figure.
Figure.
Kaplan-Meier curve demonstrating artificial urinary sphincter (AUS) device survival according to type of urethroplasty. Here, device survival equals surgical revision for any reason.
Figure.
Figure.
Artificial urinary sphincter (AUS) device survival according to type of urethroplasty. A, Surgical revision due to any reason (log-rank, P = .0006). B, Surgical revision due to urethral erosion (log-rank, P = .01). C, Surgical revision due to urethral atrophy (log-rank, P = .03).
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Johnsen NV. Johnsen NV. J Urol. 2026 Feb;215(2):212. doi: 10.1097/JU.0000000000004812. Epub 2025 Oct 24. J Urol. 2026. PMID: 41133762 No abstract available.
  • Editorial Comment.
    Passarelli R, Patel HV. Passarelli R, et al. J Urol. 2026 Feb;215(2):210-211. doi: 10.1097/JU.0000000000004813. Epub 2025 Oct 24. J Urol. 2026. PMID: 41133780 No abstract available.

References

    1. Biardeau X, Aharony S, Campeau L, Corcos J; AUS Consensus Group. Artificial urinary sphincter: report of the 2015 consensus conference. Neurourol Urodyn. 2016;35(suppl 2):S8-S24. doi: 10.1002/nau.22989 - DOI - PubMed
    1. Brant WO, Erickson BA, Elliott SP, et al. Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology. 2014;84(4):934-938. doi: 10.1016/j.urology.2014.05.043 - DOI - PMC - PubMed
    1. Lin L, Sun W, Guo X, Zhou L. Artificial urinary sphincter is better than slings for moderate male stress urinary incontinence with acceptable complication rate: a systematic review and meta-analysis. Front Surg. 2022;9:841555. doi: 10.3389/fsurg.2022.841555 - DOI - PMC - PubMed
    1. McGeady JB, McAninch JW, Truesdale MD, Blaschko SD, Kenfield S, Breyer BN. Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol. 2014;192(6):1756-1761. doi: 10.1016/j.juro.2014.06.088 - DOI - PMC - PubMed
    1. Maurer V, Marks P, Dahlem R, et al. Prospective analysis of artificial urinary sphincter AMS 800 implantation after buccal mucosa graft urethroplasty. World J Urol. 2019;37(4):647-653. doi: 10.1007/s00345-019-02631-y - DOI - PubMed

Publication types