Clinical and urodynamic determinants of earlier time to failure for the artificial urinary sphincter.

OBJECTIVE: To determine clinical, surgical and urodynamic attributes associated with earlier AUS reintervention. The artificial urinary sphincter (AUS) is the gold standard treatment for post-prostatectomy stress urinary incontinence (SUI). Factors impacting long-term device survival have not been investigated.

MATERIALS AND METHODS: We identified men with post-prostatectomy incontinence who underwent AUS reintervention from 2011-2021 at a single center. Urodynamic study, pad weights and voiding diaries are routinely 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.

RESULTS: 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 intervention was associated with pad weight (p<0.01), nocturnal voids (p=0.01), bladder capacity (p=0.01), bladder volume at strong sensation (p=0.03), detrusor overactivity (p<0.01) and maximum voiding pressure (p=0.02). On multivariable analysis, earlier surgical intervention was associated with DO (HR 1.95, p<0.01 CI 1.22 to 3.1) and pad weight (HR 1.0006, p=0.02, CI 1.000 to 1.001).

CONCLUSIONS: Detrusor overactivity is associated with significantly shorter time to AUS failure. This information may allow for more individualized counseling.