Comparing long-term outcomes of first and second artificial urinary sphincter procedures

This study compared long-term outcomes of primary and secondary artificial urinary sphincters (AUS). Authors reported similar rates of treatment satisfaction, quality of life, and urinary continence between men fitted with their first AUS device and men fitted with their second device. 

Artificial urinary sphincters (AUS) can help restore continence among men with severe stress urinary incontinence. The procedure involves the implantation of an inflatable cuff around the bladder base. Inflation of the cuff prevents involuntary urine leakage, and deflation allows the passing of urine when desired. AUS are often associated with good treatment outcomes and high patient satisfaction. However, some men fitted with an AUS will need a repeat surgery to either revise the implanted device or to fit a new device. Secondary procedures are typically carried out in the case of an infection, device erosion, or failure to improve urinary symptoms. More studies are needed to compare the long-term outcomes of primary and secondary AUS. 

229 men fitted with their first AUS device and 49 men fitted with their second device were included in the study. Questionnaires recorded differences in quality of life and urinary symptoms between the two groups. Patients were followed for an average of 8.3 years.

90% of men fitted with their first device and 94% of men fitted with their second device indicated that they would undergo the procedure again. Higher age was associated with lower treatment satisfaction and lower quality of life scores.

Patients in both groups reported similar improvements in quality of life. No differences in urinary continence were observed between the two groups. 55% of men fitted with their first device and 56% of men fitted with their second device used 1 or less incontinence pads per day. Frequency of urinary leakage at least once a day was also comparable (81 and 71%), as was minimal leakage bother (64 and 55%).

Urinary continence and quality of life significantly reduced when measured at least 10 years after the procedure compared to 5 years after the procedure. 

Authors concluded that treatment satisfaction, quality of life, and urinary symptoms were comparable between men treated with their first and men treated with their second AUS procedure. However, authors also reported a significant reduction in quality of life and urinary control with greater time since the procedure.

Larger studies are needed to confirm these results.