Artificial urinary sphincter (AUS) implantation is the gold standard for surgical treatment of male stress urinary incontinence but carries a 50% long-term revision rate. Prior studies have noted medical risk factors for AUS complications such as hypertension, diabetes, cardiovascular disease, peri-operative anticoagulation use, and low pre-operative serum albumin [1]. Few studies have investigated risk factors for short term reoperation in an adult population. We sought to investigate risk factors for short-term AUS reoperation using the National Surgical Quality Improvement Program (NSPIQ) database.

Male patients who underwent AUS implantation between 2012-2022 were queried from the NSQIP database using CPT code 53445. The primary outcome was reoperation within 30 days. Patient characteristics and pre-operative laboratory findings were compared between outcome groups with the appropriate t-test, Chi-squared, or Fisher's exact test. Binary logistic regression was utilized to calculate unadjusted (univariate) and adjusted (multivariate) odds ratio for variables that were significantly different between outcomes (SPSS v 27.0).

1,884 cases were identified. Forty-three (2.3%) cases required reoperation within 30-days. Patients requiring reoperation within 30-days were older (71.9 vs 69.5, p=.033) and more likely to be insulin-dependent diabetics (IDDM) (18.6% vs 7.6%, p=.05). There was a higher percentage of African American patients in the reoperation group (20.5% vs 10.8%, p=.041). No significant associations were found between 30-day reoperation and BMI, outpatient setting, smoking history within one year, or preoperative laboratory values. There were no associations between reoperation and medical comorbidities such as non-insulin dependent diabetes, dyspnea, severe COPD, congestive heart failure, hypertension, dialysis, bleeding disorders, disseminated cancer, or immunosuppression. Univariate logistic regression found that African Americans and IDDM had a 2-fold and nearly 3-fold increased odds of reoperation within 30-days, respectively (p=.041, p=.011). When adjusting for covariates, only IDDM remained significant (aOR: 2.68, p=.020).

Patients who required short-term reoperation were more likely to be older, of African ancestry, and to have insulin-dependent diabetes. When accounting for multiple variables, only IDDM was associated with significantly increased odds of short term reoperation. Those with IDDM bear nearly 3-fold increased odds of reopration when adjusting for other covariates.

Short-term risk factors for reoperation after AUS may include increased age, IDDM, and African American race. Only IDDM remains as a significant predictor of reopration when accounting for other covariates. Preoperative diabetic counseling may improve short term AUS management, and patients with IDDM should be counseled on the increased odds of short term reoperation during consenting. Further research is required to elucidate the role of medical conditions such as diabetes in the increased odds of reoperation among African American men.

Khouri RK Jr, Ortiz NM, Dropkin BM, Joice GA, Baumgarten AS, Morey AF, Hudak SJ. Artificial Urinary Sphincter Complications: Risk Factors, Workup, and Clinical Approach. Curr Urol Rep. 2021 Mar 29;22(5):30.

Continence 7S1 (2023) 100979
DOI: 10.1016/j.cont.2023.100979