Efficacy and Safety of Artificial Urinary Sphincters in Female Patients With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis

Stress urinary incontinence (SUI) significantly affects the quality of life in women, causing social, psychological, and physical distress. While artificial urinary sphincter (AUS) implantation is a well-established treatment for male incontinence, it is less commonly used in female patients and is typically considered for cases where other treatments have failed. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of AUS implantation in treating SUI in female patients, focusing on continence rates, revision rates, explant rates, and perioperative complications. A comprehensive literature search was conducted across PubMed, Scopus, Google Scholar, and the Cochrane Library in September 2024. Studies published in English over the past 15 years were included if they reported outcomes such as continence, revision, explant, and complication rates in female patients who underwent AUS implantation. Data were analyzed using Review Manager 5.4, applying a fixed-effects model where appropriate, based on heterogeneity (I² > 50%). Publication bias was assessed using funnel plots and Egger's test. Eight studies, comprising a total of 300 female patients, were included in the analysis. AUS implantation significantly improved continence rates, achieving an overall continence rate of 72% (OR = 0.01, 95% CI: 0.00 to 0.02; p < 0.00001). Revision rates were 22.5%, explant rates were 17.6%, and overall postoperative complications were 26.3%. No significant bias was detected. AUS implantation is an effective and safe treatment option for a specific group of women with SUI, particularly in cases where other standard treatments have failed. It shows satisfactory continence rates with considerable revision and explant rates. However, further large-scale, long-term studies are needed to optimize outcomes and confirm these findings.