Standardized reporting of perioperative complications after male artificial urinary sphincter implantation

TL;DR

This study evaluates complications and outcomes of artificial urinary sphincter implantation in men, using standardized reporting guidelines to improve transparency and comparability across studies.

Contribution

The study introduces standardized complication reporting for AUS implantation aligned with EAU guidelines, enhancing systematic evaluation and cross-study comparability.

Findings

47% of AUS implantations experienced complications, with bleeding being the most common.

Major complications requiring reintervention occurred in 7.9% of cases.

Explantation-free survival at 5 years was 73%, with infections and erosion being primary reasons for explantation.

Abstract

To systematically assess perioperative complications after artificial urinary sphincter (AUS) implantation using the European Association of Urology (EAU) complication reporting guidelines and evaluate long-term device outcomes.

We retrospectively analyzed male patients undergoing AUS implantation between 2015 and 2020. Demographic, clinical, and surgical characteristics were described. Early complications within 6 weeks were captured using a procedure-specific complication catalog and graded according to the Clavien–Dindo Classification (CDC), in line with EAU standardized reporting recommendations. Primary endpoints were overall and major complications (CDC grade ≥ III); secondary endpoint was explantation-free survival.

A total of consecutive 227 AUS implantations (median age 73 years, IQR 67–76) were included. Severe stress urinary incontinence was predominantly post-radical prostatectomy (81%). Cuff types included distal double cuff (58%), bulbar single cuff (26%), and transcorporal cuff (16%). Complications occurred in 47% of cases, most frequently bleeding events (61%), followed by genitourinary (12%) and infectious events (11%). Major complications requiring a reintervention occurred in 7.9% of cases. Median follow-up was 52 months (IQR 32–66), with 5-year explantation-free survival of 73%. Explantation was required in 23% of cases, primarily due to urethral erosion and infection.

AUS implantation is associated with frequent early complications, though most are minor. Applying a predefined, procedure-specific complication catalog according to EAU guidelines ensures systematic, comprehensive, and transparent reporting. This approach highlights clinically relevant events, supports cross-study comparability, and informs individualized patient counseling and perioperative management.

The online version contains supplementary material available at 10.1007/s00345-026-06246-y.

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