Post-prostatectomy incontinence is one of the most distressing complications affecting quality of life. Treatment options include observation, pelvic floor training, urethral bulking agents, male urethral sling (MUS), and artificial urinary sphincter (AUS). Despite the success of MUS in appropriately selected patients, a decline in the degree of improvement is often observed over time. An AUS may be an effective treatment option for patients who continue to experience incontinence after sling placement. However, whether prior sling placement affects the outcome of subsequent AUS implantation remains controversial. This study aims to assess the impact of prior MUS on AUS outcomes.

PRISMA statement guidelines were rigorously followed throughout this systematic review and meta-analysis. A comprehensive literature search was conducted across multiple databases, including PubMed, the Cochrane Library, Scopus, and Web of Science, to identify studies evaluating the outcomes of artificial urinary sphincter (AUS) placement. The primary outcome analyzed was AUS revision, defined as the need for device revision due to mechanical or non-mechanical failure, encompassing complications such as cuff erosion, infection, or urethral atrophy. This systematic approach ensured that all relevant studies comparing de novo AUS placement with AUS placement following prior male urethral sling (MUS) surgery were identified and critically appraised.

Four studies comparing de novo AUS placement with AUS placement after prior MUS were included, with a total of 1,050 patients. No statistically significant difference was found between the two groups regarding device revision (RR = 0.84 [0.05–15.5], P = 0.91). Additionally, no statistically significant difference was observed in non-mechanical failure (RR = 0.86 [0.40–1.81], P = 0.68).

The meta-analysis demonstrated no statistically significant difference in artificial urinary sphincter (AUS) revision rates between patients with prior male urethral sling (MUS) placement and those receiving de novo AUS. Similarly, rates of non-mechanical complications such as cuff erosion, infection, and urethral atrophy did not differ significantly between the two groups. These findings suggest that prior MUS does not negatively impact the outcomes of subsequent AUS implantation.

Artificial urinary sphincter placement remains a safe and effective treatment for persistent or recurrent stress urinary incontinence following male sling procedures. Prior sling surgery should not be considered a contraindication for AUS implantation.