Evaluating the impact of artificial intelligence-based assessment of body composition on primary artificial urinary sphincter placement outcomes

Background: Sarcopenia, characterized by low muscle mass, and aberrant adiposity changes, including visceral fat accumulation, has been associated with impaired physiologic stress response and wound healing. Artificial urinary sphincter (AUS) placement is the preferred surgical treatment for men with severe post-prostatectomy incontinence. Given the higher rates of maladaptive body composition changes in this older, high comorbidity population, this study explores their impact on AUS outcomes.

Methods: A retrospective analysis was performed including men who underwent primary AUS placement at the Mayo Clinic from 1999 to 2023 for post-prostatectomy incontinence and had cross sectional imaging available within 12 months prior to AUS implant. Sarcopenia and body composition were assessed from the available computed tomography (CT) scan using an algorithm that measures the area of different tissues at the L3 abdominal cross-section. The study investigated the association between sarcopenia [defined as skeletal muscle index (SMI) <52.4 cm²/m²] and adiposity (defined by total visceral and subcutaneous fat area) with all-cause reoperation, including specific etiologies of device infection/erosion, urethral atrophy, and device malfunction, using Cox proportional hazards models.

Results: There were 111 patients who had available imaging within the study timeframe, 61 (55%) of whom were classified as sarcopenic. Follow-up did not differ significantly between the two groups [2.11 (0.53-4.78) vs. 2.52 (0.36-5.80) years, P=0.52]. Sarcopenic patients had a lower body mass index (BMI) (29.1 vs. 32.7 kg/m²; P<0.001). No significant difference in overall device survival was observed between sarcopenic and non-sarcopenic patients (P=0.94) on Cox survival analysis. Sarcopenic patients had higher device infection rates, accounting for 16.7% (3/18) of device failures in the sarcopenic cohort compared to none in the non-sarcopenic cohort.

Conclusions: Sarcopenia was prevalent among AUS patients but did not significantly impact overall device survival. These findings suggest that AUS placement may be feasible to perform in well-selected sarcopenic patients.