Artificial urinary sphincter implantation: what do patients and urologists face?

Aim: To investigate the main problems faced by patients undergoing artificial urinary sphincter (AUS) implantation and the important factors that the surgeon should take into consideration in predicting these problems. Postprostatectomy incontinence continues to be a complication that most severely impairs the quality of life. Materials and methods: Of 82 initial patients, 64 patients with complete data who responded positively to the invitation for examination were divided into 3 groups: patients with implant-tissue interaction, patients with no problems, and those with mechanical failure. Univariate analysis, Student's t-test, Pearson's chi-square test, logistic regression, and Kaplan-Meier analysis were used in this study. Results: Of the 64 patients, 20 (31.2%) were reoperated on with a mean follow-up of 62 (range: 1-120) months. It was found that the risk of urethral erosion was higher in patients with obesity (P = 0.04), diabetes (P < 0.0001), radical prostatectomy (P < 0.0001), and adjuvant radiotherapy (P < 0.0001), and in those with the suspicion of urethral stricture who would undergo sphincter implantation within at least 3 months after the latest surgical treatment of urethral stricture, compared to other patients (P < 0.0001). Additionally, we found that surgical experience also had a strong effect on the risk of urethral erosion. Conclusion: Given increasing medicolegal awareness, patients should be informed of the possible need for reoperation, and those in the specific patient groups mentioned above should particularly be notified of a higher risk before implantation of an AUS.