The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for male stress urinary incontinence (SUI). It’s considered as the gold standard especially for treatment of moderate to severe urinary incontinence. Despite its long term use and experience related to the procedure, predictors of failure and/or all factors related to revision has not been fully understood. In the present multi-institutional patient cohort, we aimed to examine the outcomes of AUS implantation as wel as relationship between the education level and cognitive function of patients and the rate of device failure and/or re-operation (revision or replacement) rates in patients with prost prostatectomy incontinence.

Between 2007 and 2017, the data of a total of 108 patients who received AUS implantation were examined.Surgical outcome in each patient was determined and  failure of treatment, the revisions required, time to revision from the initial implantation were noted. Pre and post-operative incontinence was evaluated by a  validated questionnaire, International Consultation on Incontinence Questionnaire - short form (ICIQ-SF), whereas health related quality of life and subjective satisfaction of the patients was evaluated with the Patient Global Impression of Improvement (PGI-I) questionnaire. We also examined the role of the education level and cognitive function of patients on the development of device failure and/or re-operation (revision or replacement) rates. The education level was determined by assessing the International Standard Classification of Education (ISCED). The scale ranges from 1 (elementary school not nished) to 9 (university level).  Similarly, cognitive function was examined by using the  Mini Mental Status Examination (MMSE).  Failure was defined as start of leakage after a “dry or occasional leakage” period of at least 3 months and/or need for revision. Urinary tract infection, stone formation and difficulty on voiding due to erosion or mechanical failure necessitating replacement and/or exploration of device was also considered failure and revision

The median age of the patients was 68 years (range: 49-84), and the mean follow-up duration was 41.0 ± 37 months (range: 3-133) Table 1 shows additional demographic data, intraoperative variables,and comorbidity information. There was no perioperative severe complication. The ICIQ-SF score improved from 17.5 ± 3.2 to 5 ± 5.21 (P <.001) at the last follow-up. The median outcome on the PGI-I scale was “much better,” and 62 (57.4%) patients subjectively reported improvement. A total of 33 (30.6%) patients failed the procedure and required revision. The reasons for revisions: 7 patients developed infection, mechanical failure was present in 11 and erosion developed in 15 patients.   
The MMSE scores except moderate cognitive impairment did not affect the revision requirement. Similarly, no significant correlation was found between educational levels and revisions except level I educational level. Obesity was also found to be related to revision after AUS placement. Table 2 shows predictor factors for AUS failure/revision.

Overall treatment efficacy after AUS implantation revealed satisfactory results for the treatment of PPI. We found lowest patient education level, moderate cognitive impairment and obesity to be related to the increased rate of revisions after AUS placement.

Artificial urinary sphincter is considered the gold standard treatment modality for male stress urinary incontinence. In this study, we reported the role of educational level and MMSE of patients on the outcomes of  the procedure. Overall, AUS implantation seems to be a safe and effective treatment option for  cognitively intact, non-obese and moderate-to-well educated patients. However, additional trials  and larger series with long-term follow-up are needed to determine the predictive factors for success.