Early Efficacy and Safety Outcomes of Artificial Urinary Sphincter for Stress Urinary Incontinence Following Radical Prostatectomy or Benign Prostatic Obstruction Surgery: Results of a Large Multicentric Study

• Published in: European urology focus 2022-07, Vol.8 (4), p.1053-1059
• Main Authors: Dupuis, Hugo Georges Arthur, Bentellis, Imad, El-Akri, Mehdi, Brierre, Thibaut, Cousin, Tiffany, Gaillard, Victor, Poussot, Baptiste, Tricard, Thibault, Hermieu, Nicolas, Robin, Damien, Pitout, Alice, Beraud, Florian, Durand, Matthieu, Chevallier, Daniel, Bruyere, Franck, Biardeau, Xavier, Monsaint, Hervé, Corbel, Luc, Leon, Priscilla, Hermieu, Jean-Francois, Lecoanet, Pierre, Capon, Grégoire, Game, Xavier, Saussine, Christian, Peyronnet, Benoit, Cornu, Jean-Nicolas
• Format: Article
• Language: English
• Subjects: Artificial urinary sphincter; Benign prostatic hyperplasia; Human health and pathology; Life Sciences; Prostatectomy; Transurethral resection of the prostate; Urinary incontinence; Urology and Nephrology
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2021.09.006

Artificial urinary sphincter (AUS) is the gold standard for the management of moderate to severe stress urinary incontinence (SUI) in the male population. While outcomes of this device in postprostatectomy incontinence (PPI) are widely described, those obtained for incontinence after benign prostatic obstruction (BPO) surgery remains poorly explored. To compare continence outcomes after AUS implantation in a PPI population with those obtained in men incontinent after BPO surgery. A retrospective review of all cases of AUS implantation between 2005 and 2020 in 16 different French centers was conducted. Only patients with primary implantation whose indication was moderate to severe SUI after prostatectomy or BPO surgery were included (excluding those with a history of radiation therapy, brachytherapy, cystectomy, high-intensity focused ultrasound therapy, or neurogenic disease). The primary endpoint was the rate of social continence (zero or one pad per day) at 3 mo. Complications were also noted within 90 d of implantation. A total of 417 patients were included in the PPI group and 50 in the BPO surgery group. Social continence rates at 3 mo were similar between the groups (79% vs 72%, p = 0.701). Complication rate was significantly higher in the BPO group (8% vs 18%, p = 0.044). The same was found for the Clavien-Dindo type 2 complication rate (20.6% vs 44.4%, p = 0.026). The retrospective nature and lack of precise definition of incontinence are the main limitations of this study. This multicentric study strengthens the position of AUS as gold standard for SUI after radical prostatectomy. Comparable efficacy results were found for incontinence after BPO surgery, with nevertheless a higher rate of complications. Artificial urinary sphincter represents the gold standard for the treatment of moderate to severe stress urinary incontinence. Efficacy results are comparable between postprostatectomy incontinence and incontinence after benign prostatic obstruction surgery. This multicentric study strengthens the position of artificial urinary sphincter as the gold standard for stress urinary incontinence after radical prostatectomy. Comparable efficacy results were found for incontinence after benign prostatic obstruction surgery with nevertheless a higher rate of complications.