Artificial urinary sphincter implantation after transperineal open reconstruction of post-prostatectomy vesicourethral anastomotic stenosis

Abstract

Purpose This study evaluates the effectiveness of artificial urinary sphincter (AUS) implantation following transperineal reanastomosis in men with vesicourethral anastomotic stenosis (VUAS) and stress urinary incontinence (SUI) after radical prostatectomy (RP), focusing on long-term explantation rates and urinary continence. Methods Patients treated between 2009 and 2020 were retrospectively analyzed. Those undergoing AUS implantation post-transperineal reanastomosis for recurrent VUAS, excluding cases with prior pelvic irradiation and overactive bladder, were included. Primary outcomes were AUS explantation rates and patient-reported continence. Median follow-up was calculated using reverse Kaplan-Meier estimates, and explantation-free survival illustrated via Kaplan-Meier analyses. Results At final follow-up, 19 patients were included at a median follow-up of 79 months. Explantation occurred in 16% (N = 3) of cases, with a median time to explantation of 107 months. No urethral erosion was observed. Explantation-free survival at 2, 5, and 10 years was 100%, 87%, and 73%, respectively. The median number of pads/day decreased significantly postoperatively, with 78% (N = 14) reporting subjective continence and 89% (N = 16) achieving social continence. Conclusion AUS implantation following transperineal reanastomosis for VUAS post-RP offers favorable long-term outcomes, with low explantation rates and no erosion, making it a viable management strategy.