A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery

Abstract Objective The artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence, though evaluations of specific predictors for device outcomes are sparse. We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures. Methods We identified 2 045 consecutive AUS surgeries at Mayo Clinic (Rochester, MN) from 1983–2013. Of these, 1 079 were primary AUS implantations and 281 were initial revision surgeries and comprised our study group. Device survival rates, including overall and specific rates for device infection/erosion, urethral atrophy and mechanical failure, were compared between primary AUS placements versus revision surgeries. Patient follow-up was obtained through office examination, written correspondence, or telephone correspondence. Results During the study period, 1 079 patients (79.3%) had a primary AUS placement and 281 patients (20.7%) underwent a first revision surgery for mechanical failure or urethral atrophy. Patients undergoing revision surgery were found to have adverse 1- and 5-year AUS device survival on Kaplan-Meier analysis, 90% vs. 85% and 74% vs. 61%, respectively (p Conclusions Our findings suggest a significantly higher rate of overall device failure following revision AUS surgery, which is likely secondary to an increased rate of infection/urethral erosion events.