Back to 2014 Annual Meeting Abstracts

Background: AUS failure is commonly due to urethral atrophy/erosion, infection, or device failure. The purpose of this study was to characterize the results of AUS revisions and replacements.
Methods: Between the years 1988-2012, 261 men underwent 388 AUS placements (214), replacements (98), or revisions (76). Replacement was performed for urethral erosion/infection or mechanical failure, and revision was performed for recurrent/persistent SUI.Outcomes measured included urethral erosion, infection worsening SUI,and need for reoperation.
Results: Mean age at time of final surgery was 69.1 years and median follow-up 34.6 months. There was no difference in follow-up among the groups (p=0.16). After initial AUS placement, the rate of subsequent revision was 21% and replacement was 17%. Median times to revision and replacement after first-time AUS placement were 33.1 months and 48.6 months, respectively. Among AUS replacements, median time to erosion was 5.7 months and median time to mechanical failure was 33.1 months. AUS replacement was associated with higher rates of mechanical failure (p=0.036) and urethral erosion (p<0.001) than first-time AUS placement. AUS replacement after urethral erosion was associated with a higher rate of subsequent urethral erosions (p<0.001) than first-time AUS placement. AUS replacement after mechanical failure had no higher rate of urethral erosion (p=0.332), persistent SUI (p=0.980), or mechanical failure (p=0.112),. There was no difference between the first-time AUS placement group and the AUS revision group with regard to persistent urethral erosion (p=0.448), SUI (p=0.244), mechanical failure (p=0.310), or overall failure (p=0.336).
Conclusions: AUS replacement is associated with higher rates of mechanical failure and urethral erosion than virgin placement. AUS revision surgery is as clinically effective, safe, and durable as first-time AUS placement.