The artificial urinary sphincter (AUS) is considered the gold standard for managing post-prostatectomy stress urinary incontinence (PP-SUI) with generally favorable outcomes. However, prior radiation therapy can adversely impact surgical success. This study aimed to review and assess outcomes, including success and complication rates, comparing long-term results in irradiated versus non-irradiated patients.

We conducted a retrospective review of patients who underwent bulbar AUS placement for urodynamically confirmed PP-SUI from 2014 to 2023 . Patients who had bladder neck AUS placement or bulbar AUS for conditions other than PP-SUI were excluded. Data collected included patient demographics, intraoperative details, short- and long-term complications, and revision rates. Outcomes between irradiated and non-irradiated patients were compared, and postoperative urinary symptom scores (0-6) were used to assess quality of life (QoL).

A total of 180 patients were identified but 88 patients were included for final analysis in line with the inclusion criteria. The mean age was 69 years (±7.2 SD), were included. Mean follow-up duration was 18.4 months (±4.48 SD) with minimum 12 months follow up. Twenty-six patients had received radiation therapy (22 salvage radiotherapy post-radical prostatectomy and 6 radical radiation therapy followed by prostatectomy).
Overall, device revision was required in 18 patients (20%): 11 due to mechanical failure and 7 due to urethral cuff erosion or infection necessitating staged replacement. Complication rates were higher in the irradiated group, with urethral erosion occurring in 7 (31%) irradiated patients compared to 3 (5%) in the non-irradiated group. Device infection occurred in 4 irradiated patients compared to 3 in the non-irradiated group. 
All patients reported improved QoL post-procedure (score 0-1),  with 80% considering the operation life-changing and willing to recommend it to others. All patients who experienced device failure opted for revision surgery and were satisfied with the outcomes.

Most of the complications were reported more in patients with history of radiotherapy.
Interestingly, new onset overactive bladder symptoms, urethral strictures, and scrotal hematomas were more common in non-irradiated patients (3 vs. 2, 2 vs. 0, and 2 vs. 0, respectively).

Bulbar AUS placement is a safe and effective treatment for PP-SUI with high patient satisfaction. Although irradiated patients showed a slightly higher complication rate, long-term outcomes were satisfactory across the cohort.