TOPLINE

In older men with stress urinary incontinence undergoing artificial urinary sphincter (AUS) or urethral sling placement, frailty and being over age were independently associated with an increased risk for 30-day complications, device removal or revision within a year, and 1-year mortality.

METHODOLOGY

• Researchers conducted a retrospective cohort study of 7252 men aged 66 years or older (mean age, 74.2 years; 88% White individuals) who underwent AUS or male urethral sling placement from 2014 to 2016 to assess the impact of frailty on surgical outcomes.
• About 62% underwent AUS placement and the remainder underwent male urethral sling placement.
• Baseline frailty was quantified using the Claims-Based Frailty Index (CFI); participants were categorized as not frail, prefrail, and mildly-to-severely frail.
• The primary outcomes were 30-day complications (urinary tract infections, cardiovascular complications, acute renal failure, and wound complications), device revision or removal within 1 year, repeat stress urinary incontinence procedures within 1 year, and death within 1 year.

TAKEAWAY

• About 15% of patients had at least one complication on day 30. Factors associated with increased risk for complications in this timeframe included prefrail status (adjusted relative risk [aRR], 1.5; P < .0001) or mildly-to-severely frail status (aRR, 2.5; P < .0001), age 75-84 years (aRR, 1.2; P = .001), and age > 85 (aRR, 1.4; P = .002).
• Devise revision or removal was performed in 11% of patients within a year. Those who underwent AUS surgery had a higher risk for either within one year than those who underwent urethral sling surgery (aRR, 7.2; P < .0001).
• Increasing frailty and age were associated with an increased risk for device removal or revision.
• Prefrail status (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.4-3.3) and mildly-to-severely frail status (aHR, 3.7; 95% CI, 2.1-6.7) were associated with risk for 1 year.

IN PRACTICE

“[F]railty, independent of comorbidity, should be considered in the preoperative assessment of men undergoing consideration for SUI [stress urinary incontinence] surgery and may be an important predictor of adverse surgical outcomes in an already vulnerable and heterogenous population,” the authors wrote.

SOURCE

The study was led by Farnoosh Nik-Ahd, MD, of the University of California, San Francisco. It was published online on July 15, 2026, in The Journal of Urology.

LIMITATIONS

Data were limited to billing claims, precluding further clinical correlations to investigate the reasons for device revision or removal. The CFI was based on Medicare claims data and was not measured clinically based on a patient’s characteristics.

DISCLOSURES

The research was supported by grants from the National Institute on Aging. One of the authors served on the editorial board of The Journal of Urology and was recused from the editorial and peer review processes.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.