title: Perioperative Complications following Artificial Urinary Sphincter Placement.
abstract: OBJECTIVE
  We evaluated perioperative complications in patients undergoing primary artificial urinary sphincter placement and the potential impact of these complications on device outcomes.
  
  
  METHODS
  During the 2-year period from 2012 to 2014 we retrospectively evaluated the outcomes of 197 consecutive artificial urinary sphincter implantation procedures performed at our institution for post-prostatectomy incontinence. Of these cases 100 that were primary implantations comprise the study cohort. Perioperative complications, defined as those occurring within 6 weeks postoperatively, were classified by the Clavien-Dindo classification. After office evaluation at 6 weeks patients were followed for symptoms. Patient followup was obtained through office examination and telephone correspondence.
  
  
  RESULTS
  Patients undergoing primary artificial urinary sphincter implantation had a median age of 71.5 years (IQR 66, 76). The overall rate of any complication (Clavien I-V) within 6 weeks of surgery was 35%, including urinary retention in 31% of cases, cellulitis in 1%, device infection in 2% and urethral erosion in 2%. No significant differences in pertinent clinical comorbidities such as age (p = 0.69), hypertension (p = 0.95), coronary artery disease (p = 0.57), diabetes mellitus (p = 0.17), body mass index (p = 0.47), prior pelvic radiation therapy (p = 0.45), prior urethral sling placement (p = 0.91) or transcorporeal urethral cuff placement (p = 0.22) were found between patients with and without complications. Median followup was similar between those with and without postoperative urinary retention (p = 0.14). Postoperative urinary retention was associated with adverse 6-month device survival (76% vs 89%, p = 0.04).
  
  
  CONCLUSIONS
  The most common complication of artificial urinary sphincter placement is urinary retention. Serious adverse events following artificial urinary sphincter placement are rare. Postoperative urinary retention is associated with adverse short-term device survival rates.
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Linder
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Piotrowski
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ziegelmann
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Marcelino E
authors.initials: ME
authors.lastname: Rivera
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Rangel
authors.affiliation: Mayo Clinic, Rochester, Minnesota. Electronic address: Elliott.Daniel@mayo.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Elliott
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D016055:Urinary Retention / Q000209:etiology; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*
keywords: artificial; complications; outcome assessment (health care); urinary bladder; urinary sphincter; urination disorders