Introduction: Persistence or recurrence of stress urinary incontinence (rSUI) after artificial urinary sphincter (AUS) implantation may be secondary to mechanical failure (MECA), whose management is standardized, or to non-mechanical failure (NOMECA). In NOMECA, rSUI have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men. The primary endpoint was the complete continence status three months after revision for NOMECA. Secondary outcomes were complications, explantation-free and reoperation-free survivals. Methods: NOMECA was defined as persistence or recurrence of stress urinary incontinence (SUI), with normally functioning device, no erosion, infection or loss of fluid in the pressure regulating balloon. The exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revision for NOMECA including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), 3 increasing balloon pressure (BALLOON-UP) were performed in 10 centers. The BALLOON-UP patients were not included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were then categorized in complete vs. partial change of the device. Results: The three-month complete continence rates was 70,8% with a statistically significant difference between RELOC (100%) and DOWNSIZING (69.5%) (p=0.04). Complete change of the device was significantly associated with complete continence status at three months (83.3% vs. 63.3%; p=0.01) even in multivariate analysis (OR=2.7; CI95%:1.1-7.1; p=0.03). Complication rate at 30 days was very low (0.01%). Median follow up was 80 months. For the whole cohort, estimated 5-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9%, with no significant difference between groups (p=0.16; p=0.30). Estimated five-year explantation-free and reoperation-free survivals were significantly longer in the complete AUS change group (82.2% vs. 69.6%; p=0.03; 71.2% vs. 58.2%; p=0.047). Conclusions: AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff on the urethra. Change of all AUS components may improve functional outcomes, explantation-free and reoperation-free survivals. SOURCE OF Funding: None
