Outcomes and Device Durability of Artificial Urinary Sphincter Placement After Failed Male Urethral Sling: A Systematic Review and Meta-analysis

Abstract

To evaluate outcomes and durability of AUS implants after failed male urethral sling surgeries in comparison to primary AUS implantation. A systematic review and meta-analysis of cohort studies was performed. We compared surgical and long-term outcomes for men undergoing AUS after prior urethral sling failure with those receiving a primary AUS. Pooled effects were generated using random-effects models; dichotomous outcomes were summarized as odds ratios (ORs) and time-to-event outcomes as hazard ratios (HRs), each with 95% confidence intervals (CIs). Four cohort studies comprising 2194 men were included; 202 patients underwent AUS implantation after failed sling surgery and 1,992 underwent primary AUS implants. Across the studies, AUS after prior sling was not associated with a statistically significant increase in revision risk versus primary AUS (OR 1.67, 95% CI 0.78–3.54), although heterogeneity was substantial (I²=67%). Although pooled analysis did not show a statistically significant difference, results were unstable and sensitive to individual study effects, with sensitivity analysis suggesting a potentially significant higher revision risk after prior sling. Continence (≤1 pad/day) was comparable between groups (OR 0.93, 95% CI 0.22–3.91; I²=33%). Rates of erosion or infection did not differ significantly (OR 1.22, 95% CI 0.36–4.16; I²=0%). Prior sling was not significantly associated with device failure in time-to-event analyses (HR 2.31, 95% CI 0.88–6.05; I²=50%). In available observational evidence, AUS implantation after failed male sling surgeries demonstrates continence and complication outcomes comparable to primary AUS, while revision risk may be influenced by study-level factors and warrants further high-quality evaluation.