Artificial urinary sphincter (AUS) is one of the surgical options that can be offered to female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). However, there is a lack of high-quality data to support its use. The aim of the VENUS study was to evaluate prospectively the outcomes of AUS implantation for female SUI due to ISD. The present analysis aimed to report the characteristics of patients included in the VENUS study to assess how female AUS is currently used in expert centers across Europe

The VENUS study is EAU Research foundation (EAU-Rf) prospective registry including all female patients undergoing surgical treatment with AUS implantation surgeries (Robot-assisted, Laparoscopic, Open or other) for the treatment of female SUI due to ISD from multiple centres in Europe. SUI due to ISD was defined by a positive cough stress test with a poorly mobile/fixed urethra on physical examination and coarguments including low maximum urethral closure pressure/Abdominal leak point pressure, severe incontinence and/or failure of previous anti-incontinence surgical procedure. The present analysis focused on patients’ characteristics and surgical approaches. Statistical power calculation established that 150 patients were to be recruited.

As of October 2023, 142 patients had been included across 16 institutions from five countries (France, Spain, Belgium, Great Britain, Germany). The patients’ characteristics are summarized in table 1. The median age was 64.8 years and the vast majority of patients had undergone at least one previous SUI surgical procedure (88%). Eight patients had neurological SUI (5.6%) and seven had post-trauma SUI (4.9%). On physical examination, 82 patients were considered as having a fixed urethra (67.2%). Urodynamics were performed prior to implantation in 122 of the cases (85.9%). The mean maximum urethral closure pressure was 28.2 cmH2O and the mean abdominal leak point pressure was 16.3 cmH2O.

The patients included in the VENUS study, the prospective registry of the EAU-Rf on female AUS, are similar to those reported in existing retrospective series. The present study is the first European multicenter study. There seems to be  homogeneity in female patients undergoing AUS implantation across Europe which may help to standardize the indications. The proportion of patients with a fixed urethra is the most surprising result of the present analysis as fixed urethra is often described as one of the key features prompting female AUS implantation

In expert centers across Europe,  AUS is mostly used in female patients with persistent or recurrent SUI after one or multiple previous anti-incontinence procedure, fixed urethra on physical examination and low maximum urethral closure pressure/abdominal leak point pressure.

Continence 12S (2024) 101344
DOI: 10.1016/j.cont.2024.101344