International Neurourology Journal (Jun 2024)

Risk Factors for Artificial Urinary Sphincter Explantation and Erosion in Male Nonneurological Patients

  • Alice Pitout,
  • Pierre Lecoanet,
  • Charles Mazeaud,
  • Victor Gaillard,
  • Baptiste Poussot,
  • Thibault Tricard,
  • Christian Saussine,
  • Thibaut Brierre,
  • Xavier Game,
  • Florian Beraud,
  • Xavier Biardeau,
  • Franck Bruyere,
  • Damien Robin,
  • Mehdi El-Akri,
  • Daniel Chevallier,
  • Tiffany Cousin,
  • Grégoire Capon,
  • Jean-Nicolas Cornu,
  • Hugo Dupuis,
  • Hervé Monsaint,
  • Nicolas Hermieu,
  • Jean-François Hermieu,
  • Priscilla Léon,
  • Benoit Peyronnet,
  • Imad Bentellis

DOI
https://doi.org/10.5213/inj.2448086.043
Journal volume & issue
Vol. 28, no. 2
pp. 147 – 155

Abstract

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Purpose This study was performed to assess the risk factors for artificial urinary sphincter (AUS) explantation in a large multicenter cohort. Methods We retrospectively reviewed the medical records for all 1,233 implantations of the AMS-800 AUS device in male nonneurological patients from 2005 to 2020 across 13 French centers. Patients with neurological conditions were excluded from the study. To identify factors associated with explantation-free survival, survival analysis was performed. Explantation was defined as the complete removal of the device, whereas revision referred to the replacement of the device or its components. Results The study included 1,107 patients, of whom 281 underwent AUS explantation. The median survival without explantation was 83 months. The leading causes of explantation were infection and erosion. Univariate analysis revealed several significant risk factors for explantation: age above 75 years (34.6% in the explanted group vs. 25.8% in the nonexplanted group, P=0.007), history of radiotherapy (43.5% vs. 31.3%, P=0.001), and anticoagulant use (15% vs. 8.6%, P<0.001). In logistic regression analysis, the only significant risk factor was previous radiotherapy (odds ratio [OR], 2.05; P<0.05). Cox proportional hazards analysis revealed 2 factors associated with earlier explantation: transcorporal cuff implantation (hazard ratio [HR], 2.67; P=0.01) and the annual caseload of the center (HR, 1.08; P=0.02). When specifically examining explantation due to erosion, radiotherapy was the sole factor significantly associated with the risk of erosion (OR, 2.47; P<0.05) as well as earlier erosion (HR, 1.90; P=0.039). Conclusions In this series, conducted in a real-world setting across multiple centers with different volumes and levels of expertise, the median survival without AUS explantation was 83 months. This study confirms that radiotherapy represents the primary independent risk factor for AUS erosion in male nonneurological patients.

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