Artificial urinary sphincter (AUS) implantation is the standard of care for moderate-to-severe stress urinary incontinence (SUI). Nevertheless, few studies report on long-term outcomes of this therapy. We aimed to study AUS long-term outcomes, namely efficacy, complications, explantation rate and patient satisfaction.

We retrospectively reviewed 70 AUS implanted at our tertiary center for male SUI between January 1st 2008 to March 31st 2022. Neurogenic patients were excluded. Data regarding patients’ clinical characteristics, perioperative variables, and outcomes was retrieved and analyzed retrospectively. Patients were interviewed and completed OABSS, IPSS, ICIQ UI -SF and ICIQ-Satisfaction questionaries.

From the 70 AUS implanted in our tertiary center during the study timeframe, 21 (30%) underwent explantation and 8 (11,4%) patients died. Furthermore, two (2,9%) patients developed dementia and had their AUS deactivated and three (4,3%) were lost to follow-up.  All the remaining 36 patients completed the questionnaires.  Included patients used a mean ±SD of 5,71 ±4,05 pads per day (PPD) and 33,3% them had history of pelvic radiotherapy. Median (IQR) follow up was 76,5 (66,5) months. 33,3% of patients reported no incontinence episodes, 18% one episode or less per day and 36% reported incontinence episodes occurring several times per day. Nonetheless, among those reporting any urine loss, 66,7% reported losing only small quantities of urine, 29,2% reported moderate quantities and only 4,2% reported losing large quantities of urine. Median ICIQUI-SF (IQR) score was 4 (9) and 75% percent of patients reported using one or less PPD. Overall patients reported low incidence of LUTS as the median (IQR) IPSS score was 3 (4) and OABSS score was 1 (3,5). Regarding satisfaction, 85,7% of patients attributed maximum score to their surgical outcome, and 94,7% stated they would advise a friend to undergo AUS implantation and that they would choose AUS placement again. Patients with RT history had a significantly higher OABSS score (p=0,031) and a significantly lower ICIQ-Satisfaction score (p=0,009) when compared with patients who had never been submitted to RT. Patients with a history of a previous urethrotomy had a significantly higher IPSS score when compared with those who had never been submitted to such intervention(p=0,001).

AUS is an effective treatment for male SUI as it can achieve long-term social continence and, in some cases, absolute continence. These results are reflected in the exceptionally high patient satisfaction rates. Patients previously submitted to pelvic RT appear to have worse outcomes, with lower reported satisfaction and higher LUTS incidence. Those previously submitted to urethrotomy also appear to have higher LUTS incidence. 
Our study presents a cohort with long term follow up of patients submitted to AUS implantation in a tertiary center and one of its strengths resides on the prospective evaluation of patients and the use and collection of standardized and validated questionnaires to acess incontinence, urinary symptoms, and satisfaction.

AUS implantation is a safe and dependable technique in the treatment of SUI, achieving high continence and satisfaction rates.