title: Decline in artificial urinary sphincter survival in modern practice-do we treat a different patient?
abstract: OBJECTIVE
  Over the past few years, we have been doing an increasing number of revisions for artificial urinary sphincters (AUS) at our center. The study aims to investigate reason for this change in our practice.
  
  
  METHODS
  Demographics and surgical outcomes of patients who received AUS in 2003-2014 at our center were retrospectively evaluated, and patients were contacted to check the current status of their AUS. The outcomes of the study were: percentage of revisions and explanation, survival, and the risk factors associated with these events.
  
  
  RESULTS
  A total of 102 patients (72 years (30-87)) underwent 214 procedures: 99 primary implants, 11 secondary implants, 84 revisions, and 20 explantations-median follow-up was 54 months (5-146). The 5-years and 10-years revision-free survival for AUS were 47% and 23%, respectively. The 5 and 10 years explantation-free survival were 77% and 72%, respectively. The median time to revision for AUS implanted in 2010-2014 was shorter than in AUS implanted in 2003-2009 (6 vs. 13.5 months, P = 0.08). The percentage of AUS that were preceded by urethral surgery for incontinence was significantly higher in AUS implanted in 2010-2014 than in those implanted in 2003-2009 (19% vs. 63%, P = 0.001). The percentage of patients with AUS who received radiotherapy in the past 5 years was higher than in 2003-2009 (53% vs. 30%, P = 0.09).
  
  
  CONCLUSIONS
  In modern urological practice, more exposure to RT and previous surgeries for incontinence are associated with increased risk for revision with decline in AUS survival.
authors: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.|Department of Urology, Sohag University Hospital, Sohag, Egypt.
authors: Fawzy
authors: F
authors: Farag
authors: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Maarten
authors: M
authors: van der Doelen
authors: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Jetske
authors: J
authors: van Breda
authors: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Kathleen
authors: K
authors: D'Hauwers
authors: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: John
authors: J
authors: Heesakkers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*; D016741:Urinary Sphincter, Artificial
keywords: artificial urinary sphincter; complications; urinary incontinence