Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series.
Background/Aims/Objectives: To analyze perioperative complication and short-term explantation rates after perineal or penoscrotal single-cuff and double-cuff artificial urinary sphincter (AUS) implantation in a large middle European multi-institutional patient cohort.


METHODS
467 male patients with stress urinary incontinence underwent implantation of a perineal single-cuff (n = 152), penoscrotal single-cuff (n = 99), or perineal double-cuff (n = 216) AUS between 2010 and 2012. Postoperative complications and 6-month explantation rates were assessed. For statistical analysis, Fisher's exact test and Kruskal-Wallis rank sum test, and a multiple logistic regression model were used (p < 0.05).


RESULTS
Compared to perineal single-cuff AUS, penoscrotal single-cuff implantation led to significantly increased short-term explantation rates (8.6% (perineal) vs. 19.2% (penoscrotal), p = 0.019). The postoperative infection rate was significantly higher after double-cuff compared to single-cuff implantation (6.0% (single-cuff) vs. 13.9% (double-cuff), p = 0.019). The short-term explantation rate after primary double-cuff placement was 6.5% (p = 0.543 vs. perineal single-cuff). In multivariate analysis, the penoscrotal approach (p = 0.004), intraoperative complications (p = 0.005), postoperative bleeding (p = 0.011), and perioperative infection (p < 0.001) were independent risk factors for short-term explantation.


CONCLUSIONS
Providing data from a large contemporary multi-institutional patient cohort from high-volume and low-volume institutions, our results reflect the current standard of care in middle Europe. We indicate that the penoscrotal approach is an independent risk factor for increased short-term explantation rates.
Department of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany.
Alexander
A
Kretschmer
Tanja
T
Hüsch
Frauke
F
Thomsen
Dominik
D
Kronlachner
Alice
A
Obaje
Ralf
R
Anding
Tobias
T
Pottek
Achim
A
Rose
Roberto
R
Olianas
Alexander
A
Friedl
Wilhelm
W
Hübner
Roland
R
Homberg
Jesco
J
Pfitzenmaier
Ulrich
U
Grein
Fabian
F
Queissert
Carsten Maik
CM
Naumann
Josef
J
Schweiger
Carola
C
Wotzka
Joanne N
JN
Nyarangi-Dix
Torben
T
Hofmann
Roland
R
Seiler
Axel
A
Haferkamp
Ricarda M
RM
Bauer
D000368:Aged; D015331:Cohort Studies; D020878:Device Removal / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*