Salvage Artificial Urinary Sphincter Placement After Sling Failure: Long-Term Outcomes and Institutional Predictors in a Population-Based Cohort.

Revision of Failed Artificial Urinary Sphincter: A Comprehensive Review.

The present research provides a comprehensive systematic review of the safety and effectiveness of robotic-assisted artificial urinary sphincter (AUS) implantation in treating urodynamic stress incontinence. In line with the PRISMA framework and a protocol registered in PROSPERO, we conducted a comprehensive search of PubMed, Web of Science, and the Cochrane Library for relevant studies published from inception to August 2025. Key perioperative parameters-operative time, estimated blood loss, hospital stay, continence rate, and complication rate-were extracted. Data analysis was carried out using STATA software, with heterogeneity assessed by the I² statistic and sensitivity by leave-one-out analysis. Eight studies involving 328 patients were included. Among three comparative cohorts (n = 224), operative time did not differ between robotic and open AUS (WMD = 7.62, 95% CI [-57.94, 73.17], I²=97.4).The robotic group showed significantly more blood loss (WMD = 293.5, 95% CI [81.4, 505.75], I²=95.2), more perioperative complications (OR = 3.9, 95% CI [1.75, 8.66], I²=35.5), and more hospital stay (WMD = 4.71, 95% CI [2.26, 7.16], I²=87.5). Pooled analysis of robotic cases indicated a mean operative time of 197.06min(95% CI [177.82, 216.29], I²=86.9), mean blood loss of 19.8 mL (95% CI [14.05, 25.55], I²=0.3), hospital stay of 4.85(95% CI [4.12, 5.57], I²=88) days, and an overall complication rate of 37%(95% CI [0.27, 0.5], I²=16.6). Robot-assisted AUS implantation is a safe and effective option for treating urodynamic stress incontinence, with benefits such as reduced blood loss and faster recovery. However, the moderate risk of bias and high heterogeneity among studies limit the reliability of the findings. Larger, high-quality trials are needed to confirm its long-term efficacy.

Prostate Micro-ultrasound, Artificial Urinary Sphincters and Antibiotic Prophylaxis for Reflux

Trends in surgical treatment of female stress urinary incontinence in France over the past decade (2015-2024).

Comment on: The penoscrotal approach is a viable alternative to the perineal approach for artificial urinary sphincter implantation: a retrospective cohort study.

Simultaneous stress urinary incontinence (SUI) and erectile dysfunction (ED) are commonly caused by prostate surgery. Penile prosthesis is the gold standard for erectile dysfunction refractory to conservative therapies, fixed male sling and artificial urinary sphincter are recommended in mild and moderate/severe stress urinary incontinence respectively. The implantation of these devices can be simultaneous or delayed. This systematic review analyzes articles on simultaneous implantation of penile prosthesis and anti-incontinence devices. We search on Pubmed/Medline and Scopus: "penile prosthesis" AND "artificial urinary sphincter", "male sling", "Mini-Juppette", "ATOMS", "ProACT", "urethral bulking", "Advance", "Virtue". We have included 21 studies, mostly retrospective. The size of study cohorts is relatively small (2-65 patients) and the main cause of stress urinary incontinence and erectile dysfunction was radical prostatectomy. The average operating time appeared longer (57-218 min), although without evidence of intraoperative complications and an average hospital stay of 1-3 days. The average follow up of the studies ranged from 1 month to 94 months. Studies expressed different outcomes measurements, that could not allow a cumulative analysis. The overall continence outcomes were encouraging, with social continence rates (no more than 1 pad/day) ranging from 72 to 100%. The overall satisfaction for the inflatable penile prosthesis was high (84-100%). The postoperative complication rate did not show an augmented risk for double implants. All studies did not report any technical or surgical implant obstacles in synchronous versus metachronous implantation.

Background: Artificial urinary sphincter (AUS) implantation is the gold standard for managing persistent stress urinary incontinence after prostate cancer treatment. However, data on long-term outcomes and risk factors in Asian populations remain limited. Methods: We conducted a multi-institutional retrospective cohort study using the Chang Gung Research Database, the largest healthcare system in Taiwan, to evaluate clinical outcomes and predictors of device survival in men receiving AUS (AMS 800) implantation for incontinence after prostate cancer treatment. Baseline characteristics, perioperative factors, and comorbidities were analyzed. Device failure was defined as explantation, revision, or persistent incontinence. Logistic regression and Cox proportional hazards models were used to identify significant predictors. A nomogram for 5-year device survival was developed and internally validated. Results: A total of 50 patients were included from seven branch hospitals, with a median follow-up of 126.5 months. 5-year and 10-year device survival rates were 94% and 40%, respectively. On multivariable analysis, diabetes was consistently associated with an increased risk of device failure (HR 2.966, 95% CI 1.114–7.900). Lower BMI showed an inverse association in logistic regression (OR 0.608, 95% CI 0.397–0.932), but this did not remain significant in Cox analysis. Prior radiotherapy was not a significant risk factor (HR 0.760, 95% CI 0.264—2.190; OR 0.709, 95% CI 0.074—6.828). The nomogram demonstrated good predictive accuracy for 5-year device survival. Conclusions: AUS implantation demonstrates excellent long-term durability in Taiwanese men with incontinence after prostate cancer treatment. Diabetes consistently predicted device failure, while the role of BMI was less certain. These findings provide valuable long-term evidence on AUS outcomes in an Asian population.

How Artificial Urinary Sphincter Impacts Toileting Habits 1 Year After Implantation.

Medical malpractice after artificial urinary sphincter implantation

Transcorporal Cuff-Placement in Artificial Urinary Sphincter Surgery: A Systematic Review.

Urethral instrumentation (UI) in patients with artificial urinary sphincters (AUS) requires specific technical considerations due to the risk of urethral erosion, which can lead to serious clinical and legal consequences. Many urologists report limited preparedness for performing UI in AUS patients, particularly in emergency scenarios. This study evaluated the impact of a brief training session (TS) on urologists' self-reported confidence in managing UI in this context. Urologists and residents attending a national urology meeting in Brazil (November 2023) were invited to participate in a structured TS. The intervention included a theoretical overview of AUS components and mechanisms, device activation and deactivation, and safe catheterization techniques, followed by supervised hands-on practice using a simplified catheterization model. Confidence levels were assessed via pre- and post-training questionnaires. A total of 135 participants (100 urologists and 35 residents) took part, with a median age of 35.0 ± 10.2 years; 76.3% were men. The mean duration of the TS, including evaluations, was 15 min. Before training, only 34.1% felt capable to independently perform UI in AUS patients during emergencies. Post-training, this proportion rose to 88.8% (p < 0.001). Significant improvements were observed across all assessed competencies, including AUS deactivation, catheter selection, duration of catheterization, and device reactivation. A brief, focused training session significantly improved participants' confidence in performing UI in patients with AUS. These findings support the integration of targeted educational interventions into urologic training programs. Further studies are warranted to evaluate long-term retention and clinical outcomes.

The artificial urinary sphincter (AUS) is currently the gold standard treatment for stress urinary incontinence in men, and it's also a treatment option for women in Europe. UroActive is a new electronic device that offers remotely adjustable settings, including device pressure. This study aims to compare the range of Maximal Urethral Closure Pressures (MUCPs) covered by UroActive with those covered by the current AMS800 in male and female cadavers. Six cadavers (3 males and 3 females) were implanted with an occlusive cuff (OC) positioned around the bulbar urethra in men and around the bladder neck in women. A MUCP measurement was performed for each of the 3 different AMS800 Pressure-Regulating Balloons (PRBs): 51-60, 61-70, and 71-80 cmH2O, that were successively connected to the OC. The AMS800 PRB was then replaced by the UroActive Control Unit (CU), and MUCP measurements were performed at set pressures from 10 to 150 cmH2O. UroActive device remained fully functional (wireless communication, calibration) throughout the study period. UroActive CU achieved MUCPs values that encompassed the entire range observed with the 3 different AMS800 PRBs. A strong positive correlation between set device pressures sent to UroActive CU and MUCPs was noted in both males (r2 = 0.984) and females (r2 = 0.948). The findings suggest that UroActive provides a wide adjustable range of urethral closure pressures, potentially offering an alternative to AMS800 for managing stress urinary incontinence in both men and women. Further clinical studies are necessary to confirm its safety and effectiveness in patients.

In this case report, we describe, for the first time, the implantation of an AMS-800 sphincter (Boston Scientific Corporation, Marlborough, MA, USA) in apatient with stress incontinence following radical prostatectomy, who was ultimately treated with an perineal urethrostomy due to acomplicated course of previous incontinence therapy. The continence status and postoperative quality of life after treatment with the newly implanted sphincter system clearly demonstrate that aboutonnière deformity is not acontraindication for treatment with an artificial urinary sphincter.

The Artificial Urinary Sphincter Clinical Outcomes Trial: Primary Results.

The Artificial Urinary Sphincter Improves Emotional Health in Men With Stress Urinary Incontinence: Results From the Prospective, Multi-institutional AUSCO Study.

Artificial urinary sphincter in neurogenic versus non-neurogenic SUI: Key differences and special considerations for neurogenic cases

State of knowledge on the specialized management of urinary incontinence and pelvic organ prolapse among general practitioners in Western France in the current mesh controversy era.

Robot-assisted Artificial Urinary Sphincter (AUS) in women

In situ urethroplasty for urethral erosion after artificial urinary sphincter implantation: A 15-year clinical experience at a tertiary referral center