To date, little evidence regarding the feasibility of artificial urinary sphincter (AUS) in an ambulatory surgery (AS) setting is available in the literature, and no information on hospital readmission or complication rates have been reported yet 
Consequently, our goal was to determine the rate of complications, early revision and removal after full ambulatory implantation of bulbar AUS in men; secondly, to describe satisfaction and short-term continence rate.

Between April 2018 and April 2019, we included each patient with severe SUI who have been operated on in our dedicated AS service for implantation or revision of AUS AMS 800 (Boston scientific). In our hospital, each patient is meant to undergo AUS as an outpatient except if considered unfit for AS. Patients with an American Society of Anaesthesiologists (ASA) score of 3 or higher were considered unsuitable for AS and programmed for inpatient service. A prospective database of all included patients was established with comprehensive data collected on medical history, aetiology and severity of SUI, surgical procedures, postoperative complications and patient satisfaction.

On day 1 all patients underwent telephone surveys by the AS nursing staff and interviewed on their clinical status. Contact with healthcare professionals, patient satisfaction, pain, nausea control and any complications were recorded. 
Unanticipated admissions (UA) were defined as those patients admitted directly to the hospital from AS; readmissions as those patients who returned to the hospital in the inpatient unit after discharge from AS for strictly urological reasons.

Men were reviewed at months 2 after surgery: Patient Global Impression of Improvement (PGI-I) was used to compare the post-operative condition compared with pre-surgery status and the Likert scale was employed to measure the satisfaction on the global experience in the AS service. 

The primary outcome of this study was to determine the feasibility of AS AUS placement assessed by the rate of UA, complications, early revisions and removal. Secondary outcomes included the satisfaction and short-term continence rate in the given patient cohort.

Overall, 28 patients were included (30 consecutive procedures: 22 primary AUS placement, 6 complete revisions, 2 partial revisions), with a mean follow up of 223 ± 220.5 days. Fourteen patients had prior radiotherapy. There was only one UA (3.3%) for post-operative urinary retention, all other patients were discharged on the day of surgery accounting for a 96.7% success rate. Readmission rate was 6.7% in the first 30 days after surgery. Both revision and removal rates were 6.7%. Complications were reported in 26.7% of procedures, mainly Clavien-Dindo 1. PGI-I at 2 months after surgery showed an improved post-operative condition (score <4) after 27 procedures (90 %). Patient satisfaction of ambulatory surgery organisation and experience was high (87/5% satisfied or very satisfied). Complete continence and social continence were reached respectively after 55.6% and 88.9% procedures.

Ambulatory placement of AUS is safe and can be performed successfully. Additionally functional outcomes were also successful.

In this study, ambulatory placement of AUS appeared safe and was performed successfully in most patients. The transition from overnight hospitalisation to AS can be interesting in both financial and patient satisfaction terms. Preoperative counselling, rigorous patient selection, standardised surgical technique and early follow-up are mandatory for a successful procedure. Larger patient cohorts, randomised trials and comparison between AS and inpatients results are needed to confirm our preliminary results.

Continence 7S1 (2023) 100982
DOI: 10.1016/j.cont.2023.100982