Retrospective analysis of patients using an AMS-800 artificial urinary sphincter for stress urinary incontinence

Introduction: Stress urinary incontinence is a pathology with a significant negative impact on quality of life. At present, the Artificial Urinary Sphincter is considered the best therapeutic option for the treatment of severe stress urinary incontinence in men. (1) Goals: With this study we want to evaluate the functional result, as well as the short and long-term survival together with the most frequent type of complications that are collected in patients with Artificial Urinary Sphincter, in order to define the optimal patient profile candidate for the placement of said device. Material and methods: Descriptive and retrospective study of patients who had an Artificial Urinary Sphincter implanted in our center from January 1997 to January 2023. We analyzed demographic variables, risk factors, comorbidities, results, and complications. Results: During this period of time, a total of 59 Artificial Urinary Sphincters were implanted in our center. All patients were male, with a mean age at the time of surgery of 64 years (SD 9.20 years). The cause of stress urinary incontinence was Radical Prostatectomy in 54 cases (91.5%), of which 38 (64.4%) were retropubic and 16 (27.1%) laparoscopic. Adjuvant radiotherapy was administered in 16 cases (27.1%). The rest of the causes for which the Artificial Urinary Sphincter was implanted were replacement of the device in 3 patients (5%), TUR-type BPH surgery of the prostate in 1 patient (1.7%) and lastly intrinsic sphincter deficit in 1 patient. (1.7%). The mean follow-up was 95 months (SD 70.6 months) during which 19 patients (32.2%) suffered at least 1 complication with a mean follow-up time of 46.3 months (SD 12.65 months). The complications collected were, ordered from highest to lowest frequency: erosion of the system in 7 cases (11.9%); perineal fistula in 3 cases (5%); pump migration in 3 cases (5%); superinfection of the device and/or surgical wound in 2 cases (3.4%); mechanical failure in 1 case (1.7%); device damage due to iatrogenesis in 1 case (1.7%); and bulbar muscle atrophy in 1 case (1.7%). None of the risk factors analyzed (arterial hypertension, diabetes mellitus, smoking, adjuvant radiotherapy, among others) have a statistically significant relationship with the appearance of complications in our series. The Artificial Urinary Sphincter was removed in 15 patients (25.42%), with a mean time since its implantation of 55.9 months (SD 14.94 months). The rest of the Artificial Urinary Sphincters that are currently still functioning are 44, of which 34 (77.3%) do not require any absorbent, 5 (11.4%) require one absorbent per day, 2 (4.4%) 2 absorbents, and 3 (6.8%) 3 or more absorbents per day. Discussion: The results obtained in our study are comparable to other similar series described in the literature, which indicates that the Artificial Urinary Sphincter is a widely used device with good functional results. (2) Conclusions: The Artificial Urinary Sphincter is the treatment of choice in severe stress urinary incontinence in men, mainly after prostatic surgery, which provides notable improvement in the patient's quality of life. However, the complications associated with the device and surgery are not anecdotal, so adequate postoperative control and correct selection of candidate patients is necessary.