Surgical outcomes of artificial urinary sphincter implantation in patients with a history of urethroplasty: A retrospective analysis.

Objectives: Limited data exist on surgical outcomes following artificial urinary sphincter (AUS) implantation in patients with a history of urethroplasty for urethral stricture. This study aimed to evaluate the surgical outcomes of AUS implantation in such patients, focusing on the risk of urethral erosion.

Methods: We retrospectively reviewed 14 male patients who developed severe urinary incontinence following urethroplasty for urethral stricture and subsequently underwent AUS implantation at our center between March 2012 and January 2024. Patients underwent either excision and primary anastomosis (EPA) or non-transecting anastomotic urethroplasty (NTAU), followed by AUS implantation using either the standard or transcorporeal approach, depending on periurethral adhesions and corpus spongiosum condition. Outcomes were assessed regularly after AUS implantation, focusing on complications, especially urethral erosion.

Results: The median follow-up period after AUS implantation was 46 months. Erosion occurred in 4 of 14 patients (28.6%), all of whom had undergone EPA, while no cases of erosion were observed in patients treated with NTAU. The 12-, 36-, and 60-month AUS survival rates were 100.0%, 90.9%, and 71.6%, respectively. Patients who underwent the transcorporeal approach had comparable erosion rates to those who received the standard approach (p = 0.60).

Conclusion: Patients with a history of urethroplasty face a high risk of AUS erosion. Whether urethral transection during urethroplasty influences urethral erosion following AUS implantation requires further accumulation of cases.