Risks higher with salvage AUS, but success is possible

Although salvage artificial urinary sphincter implantations are associated with an increased risk of recurrent erosion/infection requiring explantation, excellent long-term success rates can be attained in carefully selected patients, according to a recent study.

Rochester, MN-Although salvage artificial urinary sphincter (AUS) implantations are associated with an increased risk of recurrent erosion/infection requiring explantation, excellent long-term success rates can be attained in carefully selected patients, according to a recent study.

“We have a high volume of patients that come in either for primary AUS or after previous implantations, looking for additional management. Either they had continued leakage or they had an infection or erosion, requiring it to be removed. So they come in, asking, ‘What are the chances of success with a repeated implantation?’ ” first author Brian J. Linder, MD, told Urology Times.

To answer this question, Dr. Linder and colleagues identified 704 consecutive AUS implantations performed at Mayo Clinic, Rochester, MN, between 1998 and 2012. Of these, 497 were primary implantations, 138 were revision surgeries for device malfunction, and 69 were salvage implantations. A salvage procedure was defined as placement after a previous device explantation for erosion or infection. Median follow-up for the primary cohort was 24 months for the primary AUS cohort and 34 months for the salvage patients.

After comparing outcomes between primary and salvage implantations, the authors found a significantly increased risk of infection or erosion in patients with salvage AUS compared with patients undergoing primary implantation. Specifically, 32 patients in the primary AUS arm (6.4%) experienced an erosion event compared with 13 (18.8%) in the salvage arm. In addition, 55 of the primary AUS patients (11.1%) underwent revision surgery compared with four patients (6%) in the salvage group. The findings were presented at the 2014 AUA annual meeting in Orlando, FL and subsequently published in the Journal of Urology (2014; 191:734-8).

“Comorbid conditions that would place the patient at increased risk for infection or erosion were highly prevalent-things like radiation, smoking, obesity,” Dr. Linder said.

NEXT: 5-year device survival rates 'surprising'

5-year device survival rates ‘surprising’

Interestingly, when looking at device survival, the authors found similar 5-year rates of 76% for primary AUS and 68% for salvage AUS, a finding Dr. Linder called “surprising.”

“Repeat infection/erosion after a salvage implantation is about one in five patients, but that means 80% of patients don’t have an event, and for those patients, excellent 5-year device outcomes can be achieved. It’s a feasible and promising operation for quality of life improvement in some patients after AUS erosion,” said Dr. Linder, a urology resident at Mayo Clinic, who worked on the study with Daniel S. Elliott, MD, and Mitra R. De Cogain, MD.

Dr. Linder and Dr. Elliott said they will continue following these patients to evaluate long-term device outcomes. In addition, Dr. Elliott explained that their group is planning to build a database of male artificial sphincter data that will go back to span more than 30 years.

“We’re going back to 1983,” Dr. Elliott commented.