# Decisional Regret and Long-term Quality of Life After Artificial Urinary Sphincter Implantation Following Radical Prostatectomy

## TL;DR

Most men with an artificial urinary sphincter after prostate surgery report lasting improvements, but repeat surgery increases decisional regret.

## Contribution

This study provides new insights into decisional regret and long-term quality of life after AUS implantation.

## Key findings

- AUS implantation improves continence and psychological health, but outcomes may decline over time.
- Reoperation is the strongest predictor of decisional regret.
- Better continence correlates with lower anxiety and depression.

## Abstract

Implantation of an artificial urinary sphincter (AUS) improves continence and psychological wellbeing in men with postprostatectomy incontinence, but outcomes may decline over time, and repeat AUS surgery strongly predicts decisional regret.

Insertion of an artificial urinary sphincter (AUS) is the reference treatment for stress urinary incontinence (SUI) after radical prostatectomy (RP). Although long-term outcomes have been characterised, data on decisional regret remain limited. Our aim was to evaluate decisional regret, quality of life, and the symptom burden among men with an AUS in this setting.

After ethics approval for the study, all men who had undergone RP and subsequent AUS implantation at a tertiary centre between 2012 and 2023 were identified and contacted by post. The men were invited to complete a series of validated questionnaires: Expanded Prostate Cancer Index Composite (EPIC-26), Decisional Regret Scale (DRS), and Hospital Anxiety and Depression Scale (HADS). The overall response rate was 87.5% (n = 91), with median follow-up of 82 mo (interquartile range 49–100).

Pad use significantly improved postoperatively but worsened over time; however, it remained better than at baseline. Higher pad counts correlated with higher depression scores. Overall, 35% of men reported no decisional regret, 34% mild regret, 30% moderate regret, and 1.3% severe regret. Reoperation was the only independent predictor of regret (+18 points on DRS; p = 0.001). Better continence scores correlated with lower anxiety and depression, while scores for bowel and hormonal domains also influenced psychological wellbeing.

AUS implantation provides a durable improvement in continence and psychological health for men with post-RP SUI. However, outcomes may deteriorate over time, and the need for reoperation is a significant driver of decisional regret.

We asked men who received an artificial urinary sphincter to treat urinary leakage after prostate surgery to complete questionnaires on their quality of life. Most men reported lasting improvements. Repeat sphincter surgery was linked to more regret, which shows the importance of long-term follow-up and counselling.