Salvage Artificial Urinary Sphincter Placement After Sling Failure: Long-term Outcomes and Institutional Predictors in a Population-based Cohort.

OBJECTIVES

To characterize transitions from sling to artificial urinary sphincter (AUS) and identify contributing factors.

METHODS

We analyzed longitudinal ambulatory surgery records from California's Department of Health Care Access and Information (2007-2016). Adult male California residents who underwent index AUS or sling placement were identified. Primary outcome was time to transition from sling to AUS. A multivariable Cox proportional hazards model was used to identify factors associated with salvage AUS placement among sling patients. Another univariable model compared the long-term AUS failure risk in salvage versus primary AUS recipients.

RESULTS

Our cohort comprised 1,400 sling patients from 154 facilities, with a median follow-up of 3.7 years (IQR, 1.3-5.2 years). At eight years, 20% of sling recipients required salvage AUS. In the multivariable model, a facility's higher annual AUS caseload (aHR 1.59, 95% CI 1.01-2.49) and greater patient travel distance (aHR 1.19 per 50-mile increase, 95% CI 1.00-1.40) were associated with increased likelihood of salvage AUS placement. Conversely, a high sling volume at the index center was associated with a reduced risk (aHR 0.57, 95% CI 0.38-0.84). Salvage AUS showed durability comparable to that of primary AUS (HR 0.79, 95% CI 0.55-1.13).

CONCLUSIONS

One in five sling recipients ultimately requires salvage AUS. Salvage AUS had a similar success rate to that of primary AUS. Institutional experience and geographic access influence reoperation trajectories, underscoring the importance of careful patient selection and counseling.