Risk Factors for Short Survival of AMS 800 Sphincter in Modern Urological Practice Fawzy Farag, Maarten van der Doelen, and John Heesakkers. Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.

INTRODUCTION &OBJECTIVES The study aims to determine the potential factors contributing to the increasing number of revisions of AMS 800 in modern urological practice. MATERIALS & METHODS Data of all patients who received AMS 800 at our institute between January 2003 and June 2014 were scrutinized to determine: Number of AMS 800 sphincters implanted Numbers and reasons of revisions and/or explantations Risk factors associated with potential decline in survival rates of the AMS 800 implants. Mann Whitney U-test was used to find differences between groups, Chi-Square & Fisher exact tests were used to find relation between study variables.

Etiology of Incontinence (Table 2). RESULTS 102 patients, (71±9 y) underwent 214 surgical procedures between January 2003 and June 2014 (Table 1). Etiology of Incontinence (Table 2). Baseline % Adjuvant therapies 41 Endoscopic urethrotomy for urethral stricture 19 DM 17 Previous urethral surgery to correct incontinence other than AMS 800 34 Table 1- Baseline Characteristics of 102 Patients Etiology of incontinence % Postprostatectomy 77.5 TURP 13.7 Neurogenic 5.9 Miscellaneous 2.9 Table 2- Etiology of Incontinence

Reasons for Revisions / Explantations Surgical details 102 primary- and 8 secondary AMS 800 implants 20 sphincteric explantations 84 revision of one or more components of the sphincter. Reasons for Revisions / Explantations (Table 3) Reasons for Revisions / Explantations % Erosion/infection 41 Urethral atrophy 19 System malfunction Previous urethral surgery to correct incontinence other than AMS 800 34 Table 3- Reasons for Revisions / Explantations

Survival of AMS 800 Sphincters and Risk factor for revision (Table 4) Definition: Time between the date of implantation of the AMS 800 sphincter and the date of 1st revision/explantation. This definition applies for 56 sphincters in 48 patients. Risk factor P-value 2003-2009 n=37 AMS 800 947±1002 days 2010-2014 n=19 AMS 800 317±332 days 0.09 Adjuvant therapy 11/37 (30%) 10/19 (53%) Pre-AMS urethral stricture 8/37 (22%) 5/19 (26%) 0.6 DM 7/37 (19%) 0.5 Previous urethral surgery (other than AMS 800) 12/19 (63%) 0.001 Erosion-infection 2/37 (5%) 0/19 (0%) 0.4 Table 4- Survival of AMS 800 Sphincters and Risk factor for revision

CONCLUSIONS The increasing rate of Pre-AMS 800 trials to treat SUI with other modalities such as slings and peri-AMS 800 administration of adjuvant therapies for prostatic carcinoma are associated with short survival rates of the AMS 800 sphincters.