Lower Urinary Tract Symptoms are Common After Artificial Urinary Sphincter Implantation

Abstract

Objective: To investigate lower urinary tract symptoms (LUTS) observed after artificial urinary sphincter (AUS) implantation for post-radical prostatectomy urinary incontinence (PRPUI).

Materials and methods: Cases of AUS for PRPUI were evaluated. Stress urinary incontinence (SUI) was assessed using the Sandvik-incontinence severity index. Other LUTS were evaluated using the overactive bladder symptom score and international prostate symptom score. The prevalence and predictive risk factors for post-AUS LUTS were analyzed.

Results: Of 129 patients evaluated (mean follow-up = 42.3 months, mean age = 76.7 years), 8.5% had very severe SUI, 78.4% had moderately to severely symptomatic LUTS (IPSS = 8-35 points), and 45.2% were dissatisfied with their urinary condition. Nocturia was the most prevalent (48.0%). Maximum cystometric capacity (rho = -0.236, P = .007) and involuntary detrusor contraction (P = .002) were significantly related to the severity of post-AUS urgency urinary incontinence (UUI). Multivariable linear regression analysis indicated that involuntary detrusor contraction was more associated with post-AUS urgency (P <.001) and UUI (P = .006) than any other preoperative parameter. Age significantly correlated with the severity of post-AUS urgency (rho = 0.309, P <.001), UUI (rho = 0.196, P = .026), and the need for straining to void (rho = 0.240, P = .007).

Conclusion: Even after successful placement of an AUS, many patients were dissatisfied with various LUTS, ranging from the most frequent nocturia to the need for straining to void. Attention should be paid not only to SUI but also to non-SUI LUTS, which are observed in the general population in this age group and change over time. Counseling to educate patients about expected outcomes and continuous monitoring and treatment for LUTS should be provided for the PRPUI-AUS population.