Male Hypogonadism Does Not Affect Surgical Outcomes After Primary Artificial Urinary Sphincter Placement

Abstract

Purpose: Studies suggest a link between hypogonadism and complications after artificial urinary sphincter (AUS) placement. We investigated this association and evaluated whether testosterone replacement therapy (TRT) before AUS placement attenuates this risk in hypogonadal patients. Materials and Methods: A retrospective cohort study was conducted using the TriNetX network between 2008 and 2022. We defined 2 groups undergoing primary AUS: (1) eugonadal and (2) hypogonadal patients. We further assessed the hypogonadal cohort by comparing TRT recipients with TRT-naïve patients before AUS. Propensity score matching was used to account for differences in covariates between eugonadal and hypogonadal cohorts. Outcomes included 5-year all-cause revision, erosion, mechanical failure, or device infection. Results: A total of 4308 eugonadal and 514 hypogonadal patients (95 with TRT, 409 TRT-naïve) were included. After matching, the eugonadal and hypogonadal cohorts each contained 504 patients. The median follow-up times for the eugonadal and hypogonadal cohorts were 6 and 5 years, respectively. We found no difference in 5-year all-cause revision (25% vs 28%, P = .35), erosion (1.2% vs 2.2%, P = .22), device infection (3.6% vs 4.0%, P = .74), or mechanical failure (16% vs 17%, P = .67) between eugonadal and hypogonadal patients. In the hypogonadal subanalysis, we found no difference in 5-year device outcomes between TRT recipients and TRT-naïve patients. Post-AUS, only 22 (5%) patients in the TRT-naïve arm received new TRT, suggesting minimal crossover. Conclusions: In matched cohorts of eugonadal and hypogonadal patients undergoing primary AUS placement, we observed no difference in 5-year device outcomes. TRT does not appear to affect surgical outcomes in hypogonadal patients undergoing AUS placement. These hypothesis-generating findings warrant further evaluation.