Hypothesis / aims of study
Stress urinary incontinence (SUI) substantially impacts quality of life among women, necessitating effective interventions when
conservative treatments fail. Although artificial urinary sphincter (AUS) implantation is a common treatment for male incontinence, its use in female patients remains limited. This systematic review and meta-analysis evaluated the effectiveness and safety of AUS
implantation for SUI in females, with key outcomes including continence rates, revision rates, explant rates, and peri-operative
complications.
Study design, materials and methods
A systematic search of PubMed, Scopus, Google Scholar, and Cochrane Library was conducted in September 2024 to identify
relevant studies published within the past 15 years. Eligible studies included adult women with SUI treated via AUS implantation,
with at least six months of follow-up. Data on continence, revision, explant, and complication rates were analyzed using Review
Manager 5.4 with a fixed-effects model. Publication bias was assessed through funnel plots and Egger's test.
Results
Eight studies involving 300 female patients met the inclusion criteria. AUS implantation significantly improved continence, with a
mean rate of 72% (Odds Ratio = 0.01, 95% Confidence Interval: 0.00-0.02; p < 0.00001). Revision rates averaged 22.5%, often due
to mechanical adjustments or device malfunction, while explant rates were 17.6%, typically related to infection or erosion. Overall,
26.3% experienced postoperative complications, including urinary retention (4.7%), infections (6.3%), and device erosion (4.3%).
Interpretation of results
The findings of this study confirm that AUS implantation is a highly effective intervention for managing severe SUI in female patients, significantly improving continence rates and quality of life. However, the procedure is not without risks, as complications such as mechanical failure, infections, and tissue-related issues remain common. The necessity for re-operation, whether for device malfunction or urethral complications, highlights the importance of long-term follow-up and patient counseling.
Despite these complications, patient satisfaction remains favorable, suggesting that the benefits of regaining urinary control often outweigh the risks associated with AUS implantation. The variability in reported outcomes across studies suggests that factors such as surgical technique, patient selection, and postoperative management play a critical role in determining success rates. While AUS is traditionally considered a last resort after the failure of other therapies, its effectiveness suggests it could be considered earlier in the treatment pathway for select patients with severe or refractory SUI.
Future research should focus on improving device durability to reduce mechanical failures, optimizing surgical techniques to lower erosion and infection risks, and identifying patient characteristics that predict better long-term outcomes.
Concluding message
AUS implantation appears promising as a second-line surgical option for women with refractory SUI, achieving satisfactory
continence rates with manageable revision and explant rates. However, given the moderate rate of complications, continued
evaluation and further randomized studies are necessary to better define the comparative effectiveness, refine patient selection
criteria, and optimize treatment outcomes.