Clinical and Urodynamic Determinants of Earlier Time to Failure for the Artificial Urinary Sphincter

OBJECTIVETo determine clinical, surgical and urodynamic attributes associated with earlier AUS reinterven-tion. The artificial urinary sphincter (AUS) is the gold standard treatment for postprostatectomy stress urinary incontinence. Factors impacting long-term device survival have not been investigated.MATERIALS AND METHODSWe identified men with post-prostatectomy incontinence who underwent AUS reintervention from 2011 to 2021 at a single center. Urodynamic study, pad weights and voiding diaries are rou-tinely assessed prior to AUS placement. Relationships between clinical, urodynamic and surgical variables and AUS reintervention were assessed using cox regression. Multiple imputation of chained equations was used to handle missing data elements, with truncated linear regression for continuous variables and logistic regression for binary variables.RESULTSA total of 524 records were reviewed and 92 met inclusion. Median time to AUS reintervention was 5.7 years (2.3, 9.4). Indications were mechanical failure (38; 41.3%), sub-cuff atrophy (37; 40.2%), erosion/infection (11; 11.9%) and other (6; 6.5%). On univariable testing, earlier inter-vention was associated with pad weight (P < .01), nocturnal voids (P = .01), bladder capacity (P = .01), bladder volume at strong sensation (P = .03), detrusor overactivity (P < .01) and maxi-mum voiding pressure (P = .02). On multivariable analysis, earlier surgical intervention was associ-ated with detrusor overactivity (HR 1.95, P < .01 CI 1.22-3.1) and pad weight (HR 1.0006, P = .02, CI 1.000-1.001).CONCLUSIONSDetrusor overactivity is associated with significantly shorter time to AUS failure. This information may allow for more individualized counseling. UROLOGY 176: 200-205, 2023. & COPY; 2023 Elsevier Inc.