# Long-Term Outcomes and Predictors of Artificial Urinary Sphincter Survival After Prostate Cancer Treatment: A Multicenter Cohort Study

## TL;DR

This study examines long-term outcomes of artificial urinary sphincter implants in Taiwanese men with prostate cancer-related incontinence, finding that diabetes increases device failure risk.

## Contribution

The study provides novel long-term data on artificial urinary sphincter survival in an Asian population, identifying diabetes as a significant predictor of device failure.

## Key findings

- 5-year and 10-year device survival rates were 94% and 40%, respectively.
- Diabetes was consistently associated with increased risk of device failure (HR 2.966).
- A nomogram for predicting 5-year device survival showed good accuracy.

## Abstract

Background: Artificial urinary sphincter (AUS) implantation is the gold standard for managing persistent stress urinary incontinence after prostate cancer treatment. However, data on long-term outcomes and risk factors in Asian populations remain limited. Methods: We conducted a multi-institutional retrospective cohort study using the Chang Gung Research Database, the largest healthcare system in Taiwan, to evaluate clinical outcomes and predictors of device survival in men receiving AUS (AMS 800) implantation for incontinence after prostate cancer treatment. Baseline characteristics, perioperative factors, and comorbidities were analyzed. Device failure was defined as explantation, revision, or persistent incontinence. Logistic regression and Cox proportional hazards models were used to identify significant predictors. A nomogram for 5-year device survival was developed and internally validated. Results: A total of 50 patients were included from seven branch hospitals, with a median follow-up of 126.5 months. 5-year and 10-year device survival rates were 94% and 40%, respectively. On multivariable analysis, diabetes was consistently associated with an increased risk of device failure (HR 2.966, 95% CI 1.114–7.900). Lower BMI showed an inverse association in logistic regression (OR 0.608, 95% CI 0.397–0.932), but this did not remain significant in Cox analysis. Prior radiotherapy was not a significant risk factor (HR 0.760, 95% CI 0.264—2.190; OR 0.709, 95% CI 0.074—6.828). The nomogram demonstrated good predictive accuracy for 5-year device survival. Conclusions: AUS implantation demonstrates excellent long-term durability in Taiwanese men with incontinence after prostate cancer treatment. Diabetes consistently predicted device failure, while the role of BMI was less certain. These findings provide valuable long-term evidence on AUS outcomes in an Asian population.