Male artificial urinary sphincter: long-term efficacy and patient satisfaction

Esfínter urinario artificial masculino: eficacia a largo plazo y satisfacción del paciente

Background: Artificial urinary sphincter (AUS) implantation is the standard of care for moderate-to-severe stress urinary incontinence (SUI), but long-term outcome data remain limited. We aimed to assess AUS’ long-term efficacy, complications, explantation rate, and patient satisfaction. Methods: We retrospectively reviewed 70 male patients who underwent AUS (American Medical Systems (AMS) 800™) implantation for SUI at our tertiary center between 2008 and 2022. Neurogenic patients were excluded. Clinical and perioperative data were analyzed, including comorbidities (e.g., diabetes, hypertension), history of pelvic radiotherapy, previous urethral stricture and/or surgical treatments (e.g., suburethral sling, prior AUS). Patients completed the International Prostate Symptom Score (IPSS), International Consultation on Incontinence-Urinary incontinence Short Form (ICIQ-UI SF), Overactive Bladder Symptom Score (OABSS), and ICIQ-Satisfaction questionnaires during follow-up. Main outcomes were continence and explantation rates. Results: The mean age at surgery was 66.5 years, with a mean follow-up of 72 months. AUS explantation occurred in 21 cases (30%): 11 due to mechanical failure and 10 due to infection. Among the 36 patients alive and actively using their AUS, 33.3% reported no incontinence episodes, 30.6% one episode or less per day, and 36.1% multiple episodes per day. However, 38.5% of the latter reported losing small quantities of urine. The median ICIQ-UI SF score was 4, with 75% of patients using one or fewer pads daily. The median IPSS score was 3 and OABSS score was 1, indicating low lower urinary tract symptoms prevalence. Patient satisfaction was high, with 85.7% rating their surgical outcome as excellent and 94.7% stated they would recommend AUS or choose to undergo the procedure again. Conclusions: AUS is an effective long-term treatment for male SUI, achieving social or absolute continence in many cases. Patient satisfaction remains high despite the need for revisions or explantations.

Resumen

Antecedentes: La implantación de un esfínter urinario artificial (EUA) es el tratamiento estándar para la incontinencia urinaria de esfuerzo (IUE) de moderada a grave, aunque los datos sobre sus resultados a largo plazo siguen siendo limitados. Nuestro objetivo fue evaluar la eficacia a largo plazo del EUA, sus complicaciones, la tasa de explantación y la satisfacción de los pacientes. Métodos: Se revisaron retrospectivamente 70 pacientes varones que se sometieron a la implantación de un EUA (American Medical Systems (AMS) 800™) para IUE en nuestro centro terciario entre 2008 y 2022. Se excluyeron los pacientes con patología neurogénica. Se analizaron datos clínicos y perioperatorios, incluidas comorbilidades (por ejemplo, diabetes, hipertensión), antecedentes de radioterapia pélvica, estenosis uretral previa y/o tratamientos quirúrgicos (por ejemplo, cabestrillo suburetral, EUA previo). Durante el seguimiento, los pacientes completaron los cuestionarios International Prostate Symptom Score (IPSS), International Consultation on Incontinence-Urinary incontinence Short Form (ICIQ-UI SF), Overactive Bladder Symptom Score (OABSS), e ICIQ-Satisfaction. Los principales resultados fueron las tasas de continencia y de explantación. Resultados: La edad media al momento de la cirugía fue de 66.5 años, con un seguimiento medio de 72 meses. Se realizó la explantación del EUA en 21 casos (30%): 11 por fallo mecánico y 10 por infección. Entre los 36 pacientes vivos que utilizaban activamente su EUA, el 33.3% no presentaban episodios de incontinencia, el 30.6%presentaban un episodio o menos al día y el 36.1% varios episodios diarios. Sin embargo, el 38.5% de este último grupo refería pérdidas de pequeñas cantidades de orina. La mediana del puntaje ICIQ-UI SF fue 4, con el 75% de los pacientes utilizando uno o menos absorbentes al día. La mediana del puntaje IPSS fue 3 y la del OABSS fue 1, lo que indica una baja prevalencia de síntomas del tracto urinario inferior. La satisfacción de los pacientes fue elevada, con un 85.7% calificando el resultado quirúrgico como excelente y un 94.7% afirmando que recomendarían el EUA o volverían a someterse al procedimiento. Conclusiones: El EUA es un tratamiento eficaz a largo plazo para la IUE masculina, logrando continencia social o absoluta en muchos casos. La satisfacción de los pacientes se mantiene alta a pesar de la necesidad de revisiones o explantaciones.

Artificial urinary sphincter; Urinary incontinence; Lower urinary tract symptoms

Palabras Clave

Esfínter urinario artificial; Incontinencia urinaria; Síntomas del tracto urinario inferior

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