# 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.

## Key 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.