Long-term functional outcomes of artificial urinary sphincter (AMS 800™) implantation in women aged over 75years and suffering from stress urinary incontinence caused by intrinsic sphincter deficiency.

Abstract

To assess the outcomes after artificial urinary sphincter (AUS) implantation in older women aged over 75years. A monocentric retrospective study included all non-neurological women aged over 75years suffering from stress urinary incontinence (SUI) due to intrinsic sphincter deficiency and undergoing an AUS placement between 1991 and 2015. Early postoperative complications were reported according to Clavien-Dindo classification. Continence, defined as no pad use, was assessed at the end of follow-up. Explantation, revision and deactivation rates of the AUS were reported. A Kaplan-Meier survival curve was generated to evaluate the survival rate of the device without revision or explantation. Among 393 AUS implantations, a total of 45 patients, median age 77years (IQR 75-79), were included. Twenty-six early postoperative complications occurred in 18 patients (40%) patients. All were minor Clavien grades (I-II) except one (grade IVa). Median follow-up was 36months (IQR 16-96). Overall, 32 women (71.1%) still had their AUS in place at the end of the follow-up, without revision or explantation. The AUS was definitively removed in four (8.9%). The AUS required revisions in nine (20%) women. The 5- and 10-year survival rates of the device without revision or explantation were 78 and 50%, respectively. Three patients (6.7%) had their AUS deactivated. At last follow-up, in an intention-to-treat analysis, the continence rate was 68.9%. In women aged over 75-years-old, suffering from SUI, the AUS provides satisfactory functional results comparable to the general population.