title: Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection.
abstract: OBJECTIVE
  We evaluated clinical outcomes in patients treated with artificial urinary sphincter reimplantation after artificial urinary sphincter explantation for erosion or infection.
  
  
  METHODS
  We identified 704 consecutive artificial urinary sphincter implantation procedures performed at our institution from 1998 to 2012, including 497 (71%) as primary implantation and 138 (20%) as revision surgery for device malfunction. A total of 69 patients (10%) had undergone at least 1 prior artificial urinary sphincter explantation secondary to urethral erosion and/or device infection, of whom 36 (52%) were treated with 2 to 5 prior reimplantation procedures. Patient followup was performed through office examination, or written or telephone correspondence.
  
  
  RESULTS
  Patients treated with artificial urinary sphincter reimplantation had a median age of 78 years (IQR 72, 80) and a median followup of 34 months (IQR 5, 61). Artificial urinary sphincter reimplantation was done a median of 9 months (IQR 6, 13) after explantation. Patients treated with reimplantation after erosion or infection were more likely to require repeat explantation than those with primary implantation (13 of 69 or 19% vs 32 of 497 or 6.4%, p = 0.002). However, when evaluating repeat procedures, the 5-year device survival rate after reimplantation due to erosion or infection vs primary implantation was 68% vs 76% (p = 0.38).
  
  
  CONCLUSIONS
  Our findings suggest that artificial urinary sphincter reimplantation after explantation for urethral erosion and/or device infection is associated with an increased rate of recurrent erosion/infection requiring repeat explantation. However, in appropriately selected and counseled patients clinically acceptable long-term device use can be achieved.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Linder
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mitra
authors.initials: M
authors.lastname: de Cogain
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: Elliott.Daniel@mayo.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Elliott
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation; D012092:Replantation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: artificial; male; replantation; stress; urinary bladder; urinary incontinence; urinary sphincter