The artificial urinary sphincter (AUS) is established as the gold therapeutic standard for post prostatectomy incontinence. There is a long history of usage of this device, and recent years brought significant improvements in reliability and reduction of complications. Our academic center has a ten year experience with implanting artificial sphincters. We aim to evaluate in a systematical manner the perception of our patients with the decision to have an AUS implanted, immediately and after one year.

We translated and adapted two validated English language questionnaires, the Satisfaction with Decision Scale (SDS) and Decisional Regret Scale (DRS). On the SDS, 1 means lowest satisfaction while 5 means the highest degree of satisfaction. On the DRS, 1 represents the lowest decisional regret while 5 means the highest level of regret. The forms were administered to the patients during the first visit after activation and at the one year follow up visit. Our patients were implanted with either the AUS 800 and the Rigicon Conti Classic devices. Demographic data was collected at the time of initial admission for the surgical implant. A retrospective analysis of objective results and complications was made and the correlation with the questionnaires was analyzed using Student’s t-test with a p value <0.05 considered significant.

Our database includes 31 AUS patients for which follow up data is available. At the moment of data analysis, the mean time since surgery was 26.3±16.7 months. The SDS score was 2.68±1.30 after activation and 3.42±1.15 after one year, p=0.02. The DRS score was 3.5±1.14 after activation and 2.6±1.07 after one year, p=0.0025. After one year, the SDS was 3.48±1.09 in the subgroup with complications and 3.16±1.89 in the subgroup with no complications, p=0.29. The DRS was 2.84±1.29 in the subgroup with complications and 2.68±1.25 in the subgroup where no complications were reported. Since the series is quite small, no relevant differences could be demonstrated between the two types of AUS.

The main take away from our study is that the perception of the patient is different compared to what the physician evaluates based on objective data.

Patient perceptions are not significantly associated with objective data, thus increasing the necessity to be specifically evaluated. Shortly after activation, our patients showed lower satisfaction and higher regret towards their decision. After one year, despite some of them encountering surgical complications, the satisfaction rate increased while the decision regret lowered. This aspect should be discussed with the patient before his surgery. Satisfaction rates should become part of any scientific report of the outcomes of AUS implantation.