Artificial urinary sphincter (AUS) implantation is a well-established surgical treatment for male stress urinary incontinence. However, postoperative management strategies vary, with some centers opting for same-day catheter-free discharge (SDS) while others prefer overnight observation (OBS) to monitor potential complications. The optimal approach remains unclear. This systematic review and meta-analysis aim to compare SDS and OBS in terms of postoperative complications, including urinary retention, emergency department visits, and suprapubic catheter placement rates.

A systematic search of PubMed, Scopus, the Cochrane Library, Google Scholar, and ClinicalTrials.gov databases was conducted up to 2024. Keywords used included “discharge,” “artificial urinary sphincter,” and “incontinence.” References from relevant studies were also reviewed. Data were pooled using RevMan 5.4 software. The Cochrane risk of bias tool was employed for study quality assessment. Inclusion criteria were adult men with a clinically confirmed diagnosis of urinary incontinence who underwent AUS implantation. Abstracts and unpublished papers were excluded.

Six clinical trials met the inclusion criteria for the systematic review, of which four were included in the meta-analysis. The urinary retention rate showed no statistically significant difference between SDS and OBS (RR = 1.44, 95% CI: [0.81, 2.56], p = 0.21) (Figure 1). Similarly, there was no significant difference in emergency department visits within 90 days post-surgery (RR = 0.91, 95% CI: [0.59, 1.42], p = 0.69) (Figure 2). However, SDS was associated with significantly fewer cases of suprapubic catheter placement compared to OBS (RR = 0.28, 95% CI: [0.09, 0.81], p = 0.02) (Figure 3).

The findings suggest that SDS does not increase the risk of urinary retention or emergency department visits compared to OBS. These results indicate that many patients undergoing AUS implantation may not require overnight hospitalization. 
Avoiding overnight hospitalization may also contribute to lower healthcare costs and higher patient satisfaction by reducing hospital stay duration without compromising safety. However, the success of SDS likely depends on proper patient selection, perioperative management, and close postoperative follow-up to promptly address any complications. While the results favor SDS as a safe and effective alternative to OBS, certain limitations should be considered. The included studies had heterogeneous sample sizes, and variations in postoperative protocols across studies may have influenced the results. Additionally, most studies were observational, limiting the ability to establish causation.

Same day catheter-free discharge (SDS) after AUS implantation appears to be a safe and effective alternative to overnight observation (OBS). SDS reduces the need for suprapubic catheter placement without increasing the risk of urinary retention or unplanned healthcare visits. Further high-quality studies are needed to confirm these findings and refine postoperative protocols for AUS implantation.