Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: functional results and assessment of reoperative procedures.

Artificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation. Data from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS). Median follow-up was 20 vs. 25 months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS p=0.014).In our population, 54% patients were considered as"dry" in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70 years was predictive of more reinterventions, whereas the use of a 4.5 cm cuff was protective, with hazard ratios of 1.42 (p=0.001) and 0.78 (p=0.04) respectively. The penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings.

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