title: Risk factors for artificial urinary sphincter failure.
abstract: OBJECTIVE
  To analyze revision rates and risk factors for artificial urinary sphincter failure.
  
  
  METHODS
  Eighty-four patients underwent implantation of an artificial urinary sphincter in one reference center. Continence rates were defined by daily pad usage. Influence of predefined risk factors for device explantation, revision, differences in preoperative pad usage, and device survival was analyzed using Chi-squared test, Wilcoxon signed-rank test, and Kaplan-Meier analysis. A multivariate analysis was performed using a logistic regression model. A p value below 0.05 was considered statistically significant.
  
  
  RESULTS
  After a mean follow-up of 39.7 months, the device was still in situ in 64 patients. In univariate analysis, perioperative need of anticoagulation led to a significant increase in urethral erosion (6 vs. 30 %; p = 0.002) and explantation rate (15 vs. 34 %; p = 0.047). Pelvic irradiation increased postoperative infection rates significantly (0 vs. 10 %; p = 0.018). Penoscrotal approach led to significant increase in urethral erosion rate (0 vs. 21 %; p = 0.015). Implantation of a double cuff led to a significant increase in explantation rate (58 vs. 24 %; p = 0.014), revision rate (75 vs. 38 %; p = 0.017), and infection rate (17 vs. 1 %; p = 0.008). When using cuff size of 3.5 cm, revision rate (20 vs. 50 %; p = 0.026) as well as incontinence rates (40 vs. 82 %; p = 0.014) was significantly lower. In multivariate analysis, only perioperative anticoagulation and double-cuff placement were independent predictors of artificial urinary sphincter failure.
  
  
  CONCLUSIONS
  Our findings highlight the influence of perioperative anticoagulative therapy. In addition, the current study provides further evidence that double-cuff implantation should be performed only with caution during primary implantation.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany. Alexander.kretschmer@med.uni-muenchen.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kretschmer
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Grabbert
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Micaela
authors.initials: M
authors.lastname: Pavlicek
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Ricarda M
authors.initials: RM
authors.lastname: Bauer
mesh_terms: D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*
keywords: Artificial urinary sphincter; Complications; Efficacy; Male urinary stress incontinence; Risk factors