Temporal trends in patients undergoing artificial urinary sphincter implantation: explantation outcomes and early failure patterns in a tertiary reconstructive referral center

Background Baseline characteristics and perioperative risk profiles in patients undergoing artificial urinary sphincter (AUS) implantation have changed over time, potentially influencing clinical outcomes. This study assessed temporal trends in patient characteristics and explantation outcomes to inform preoperative counselling and risk stratification. Materials and methods This retrospective study included male patients undergoing AUS implantation between 2009 and 2025, stratified into four implantation periods. Explantation-free survival was analyzed using the Kaplan-Meier method. Risk factors for explantation were evaluated using multivariable Cox proportional hazards regression models. Results A total of 491 patients were included (2009–2012: N = 177; 2013–2017: N = 159; 2018–2022: N = 107; 2023–2025: N = 48), with a median follow-up of 54 months (IQR 14–116). Baseline characteristics were largely comparable, with a relative increase in prior radiotherapy from 35% to 42% over time. Explantation rates were 36%, 27%, 22%, and 17%, respectively, predominantly due to erosion and infection. In multivariable analysis, prior radiotherapy (HR 1.88, 95% CI 1.30–2.70), prior BPH surgery (HR 1.75, 95% CI 1.10–2.77), and prior bulbar urethroplasty (HR 2.10, 95% CI 1.12–3.93) were independent predictors of explantation. Kaplan-Meier analysis showed no significant differences in explantation-free survival between periods ( p = 0.8), although a numerical increase in early explantations within 24 months was observed (7.9% to 13%). In a supplementary analysis focusing on early explantation, prior radiotherapy (HR 2.46, 95% CI 1.38–4.39) and prior urethral surgery (HR 2.50, 95% CI 1.31–4.77) were independently associated with increased risk. Later implantation periods showed an increase in early explantation risk; however, this did not reach statistical significance. The study is limited by its retrospective single-center design. Conclusion The AUS remains a durable and effective treatment option for male incontinence, with stable outcomes across implantation periods. Careful preoperative counselling and structured follow-up remain essential, particularly in high-risk patients.