Artificial urinary sphincter surgery in the UK: are we following the guidelines?

Abstract

Introduction: Artificial urinary sphincter (AUS) is a guideline-recommended treatment for male stress urinary incontinence. Despite its widespread use, it is thought that there is no standardisation in AUS practice. This study aims to report current AUS insertion practices in the UK and highlight any discrepancies.

Methods: A REDCap survey was conducted under the British Association of Urological Surgeons (BAUS) Section of Female, Neurological, and Urodynamic Urology, and reported using the CHERRIES checklist. Outcomes were framed using the International Continence Society (ICS) document and recent BAUS consensus document.

Results: The survey received 34 responses (response rate: 44-94%). Most respondents (80%) used video-urodynamics and patient-reported outcomes in patient workup. Loss of compliance on urodynamics was the most common contraindication, and detrusor overactivity was often treated before AUS surgery. Perioperative preparation and implantation techniques varied significantly from the ICS document, as did complication management.

Conclusions: The reported variation may result from local or national influences, a lack of high-quality evidence and divergent surgical training. This variability impacts the heterogeneity of outcomes and their reporting. Future efforts should focus on adopting the new national consensus to standardise practice, improving training curricula, researching the effects of variability on surgical outcomes and enhancing the quality of evidence in this field.

Keywords: Artificial; Genitourinary sphincter; Male incontinence; Prostate surgery; Urinary stress incontinence.