How Artificial Urinary Sphincter Impacts Toileting Habits 1 Year After Implantation

Background and objective: An artificial urinary sphincter (AUS) is a gold standard treatment for moderate to severe male stress urinary incontinence (SUI). The objective of this study was to evaluate whether self-reported toileting behaviors are associated with quality of life (QOL) following AUS implantation. Methods: Artificial Urinary Sphincter Clinical Outcomes (AUSCO) is a prospective, multicenter study evaluating the AMS 800 AUS in men with primary SUI. A total of 115 participants were implanted at 17 sites, with follow-up at 3, 6, and 12 mo. Patients with predominant overactive bladder symptoms were preoperatively excluded from participation. Participants reported on incontinence events (voiding diaries), toileting habits, device use, and satisfaction. QOL was assessed via questionnaires such as the Incontinence Quality of Life (I-QOL), Incontinence Impact Questionnaire (IIQ-7), and EQ-5D-5L. Key findings and limitations: Of the participants, 94% achieved ≥50% reduction in pad weight and 92% reported satisfaction at 12 mo. Significant improvements were observed in I-QOL, IIQ-7, and EQ-5D-5L scores (p < 0.001). Reduction in pad weight and ease of device use were strong predictors of both satisfaction and QOL improvement. Voiding diary–based stress and urgency incontinence events declined significantly, but changes in toileting habits (eg, sitting vs standing and urinal vs stall use) were minimal and not associated with satisfaction. Postvoid dribbling persisted in 68% of patients at 12 mo, despite an improvement from baseline (p = 0.02). Functional limitations in self-care and mobility predicted more difficulty in using the device. Conclusions and clinical implications: AUS implantation results in high satisfaction and substantial improvements in continence and QOL at 1 yr. Ease of use and effectiveness are key drivers of satisfaction, while toileting behaviors appear largely unchanged following implant. These findings offer valuable insights to guide preoperative counseling and patient selection.