The impact of surgical sequence on outcome rates of artificial urinary sphincter implantation: comparative effectiveness of primary, secondary and repeat implantation

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To determine whether salvage artificial urinary sphincter (AUS) implantation after prior incontinence surgery achieves outcomes comparable to primary AUS implantation.


We retrospectively evaluated data of patients undergoing AUS implantation from 2009 to 2014. Functional outcome was objectified by 1-h stress pad test, uroflowmetry, post-void residual urine measurement, clinical examination, and chart review. Complications were categorized according to Clavien–Dindo classification system. Kaplan–Meier analysis determined explantation-free survival.


A total of 235 patients were included of whom 165 (70.2%) underwent primary AUS. In 70 patients, salvage incontinence surgery was performed, with 24 (10.2%) patients undergoing AUS reimplantation after prior AUS surgery (repeat AUS) and 46 (19.6%) patients undergoing AUS surgery after any other type of incontinence surgery (secondary AUS). There were no significant differences in rates of continence among primary AUS and repeat AUS patients. Patients undergoing secondary AUS had significantly better continence rates than primary and repeat AUS patients. Three-year explantation-free survival rates after AUS insertion were 82.3% (primary AUS), 78.6% (repeat AUS) and 81.5% (secondary AUS). There were no differences in complication rates among the groups.


AUS is a safe option in the treatment of severe incontinence even after prior AUS or any other prior incontinence surgery and can still achieve satisfactory outcomes as salvage treatment.

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Author information




CMR: project development, data management, data analysis, manuscript writing and editing. TP: project development, data management, and manuscript writing. RD: project development and manuscript editing. VM: project development, manuscript editing, and data management. PM: project development, manuscript editing, and data management. MWV: project development and manuscript editing. MF: project development and manuscript editing. TL: project development, data collection and management, data analysis, and manuscript editing.

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Correspondence to Clemens M. Rosenbaum.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Clemens M. Rosenbaum: on behalf of the Trauma and Reconstructive Urology Working Party of the European Association of Urology (EAU) Young Academic Urologists (YAU).

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Rosenbaum, C.M., Pham, T., Dahlem, R. et al. The impact of surgical sequence on outcome rates of artificial urinary sphincter implantation: comparative effectiveness of primary, secondary and repeat implantation. World J Urol 38, 2289–2294 (2020).

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  • AMS 800
  • Artificial urinary sphincter
  • Reoperation
  • Stress urinary incontinence
  • Surgical sequence