Complications of stress urinary incontinence surgery in men: a comparative analysis of urethral sling versus artificial urinary sphincter from a large national database

Background: Stress urinary incontinence (SUI) in men, often due to radical prostatectomy or sphincter deficiency, impacts quality of life. Surgical options include artificial urinary sphincter (AUS) and male urethral slings, valued for lower risks and cost. Understanding their outcomes aids in patient care. Objectives: To compare 30-day postoperative outcomes in AUS versus sling implantation in males. Design: Retrospective cohort study using a multicenter database. Methods: Male patients who underwent sling or AUS implantation between 2008 and 2022 were identified in the National Surgical Quality Improvement Program (NSQIP) database using current procedural terminology (CPT) codes. Patient characteristics, intraoperative factors, and 30-day outcomes were extracted and compared. Multivariate logistic regression adjusted for age, body mass index (BMI), race, ASA classification, anesthesia technique, smoking status, history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, hypertension requiring medication, bleeding disorders, and chronic steroid use. A 1:1 propensity score–matched analysis was also conducted. Results: Among 4,498 patients, 39.6% received slings and 60.4% AUS. After adjustment, AUS was associated with higher odds of 30-day complications (OR 1.48 (1.09–2.02), p = 0.012), including surgical site infections (OR 2.19), overall infections (OR 1.84), implant complications (OR 4.08), genitourinary complications (OR 2.31), unplanned reoperation (OR 2.04), Clavien-Dindo Grade I–II (OR 1.58) and Grade III complications (OR 2.10), and prolonged hospital stay (OR 4.66–5.71; all p < 0.001). The 1:1 matched analysis largely supported these findings. Conclusion: AUS implantation is associated with higher 30-day postoperative complication rates compared to male urethral sling placement. These results may guide surgeons in their perioperative counseling regarding the short-term complication rates of both procedures, but further studies are needed to assess the long-term outcomes.