Complex artificial urinary sphincter revision and reimplantation cases-how do they fare compared to virgin cases?

Purpose: We compared artificial urinary sphincter complication rates, overall reoperative rates, and continence results in virgin cases, revision cases and secondary reimplant cases (with prior erosion or infection). Materials and Methods: Only male patients with post-prostatectomy stress incontinence with AMS 800™ placement in the bulbar urethra by a single surgeon were included in the study. A total of 169 virgin cases (no prior artificial urinary sphincter surgery), 37 revision cases (eg cuff revision for urethral atrophy, revision of failed components) and 21 secondary reimplant cases (eg after prior explant from urethral erosion or infection) were compared. Results: Secondary artificial urinary sphincter reimplant cases (eg after prior explant from urethral erosion or infection) had fourfold higher future erosion rates compared to virgin cases (p = 0.02, 14.3% vs 3.6%, RR 4.02). In addition, there was no difference in the rates of other complications (device infection, urethral atrophy, mechanical failure, leaks), overall reoperation rates and postoperative continence outcomes (measured by daily pad use) compared to virgin cases. Artificial urinary sphincter revision cases did not have higher complication rates (including subsequent urethral erosion), reoperation rates or worse postoperative continence outcomes compared to virgin cases. Although the difference was not statistically significant, a trend toward higher future device leak rates (10.8% vs 3.6%, RR 3.05, p = 0.063) and higher urethral atrophy rates (16.2% vs 8.9%, RR 1.83, p = 0.18) was noted in artificial urinary sphincter revision cases compared to virgin implant cases. Conclusions: Patients with a history of artificial urinary sphincter explant have a fourfold increased risk of future cuff erosion. Nevertheless, a good functional outcome with an acceptable complication rate may be achieved in most complex reoperative artificial urinary sphincter cases.