Prevalence of Cognitive Impairment and Sphincter Misuse Among Men With Artificial Urinary Sphincters

Published:October 24, 2020DOI:


      To define the prevalence of cognitive impairment and sphincter misuse among men who had undergone AUS placement.


      Men who had previously undergone AUS placement from 2004 to 2019 were assessed through comprehensive telephone surveys. The primary survey outcome was cognitive function, assessed via validated Telephone Mini-Mental State Examination. Secondary survey outcomes included rate of AUS misuse, surgical outcomes, and overall device satisfaction. Statistical analysis was performed to assess for differences between patients with and without cognitive impairment.


      A total of 74 patients participated, with a mean age and follow-up of 75 and 7.8 years, respectively. Telephone Mini-Mental State Examination assessment revealed cognitive impairment in 18 (24%) patients, 13 (18%) with mild-moderate and 5 (7%) with severe impairment. Overall, 23 (31%) and 11 (15%) patients reported inconsistent use (not cycling AUS with every void) and device neglect, respectively. Patients with impaired cognition were more likely to report difficulty with AUS use compared to those with normal cognition (39% vs 9%, P= .01). There was no difference seen in rates of revision, rates of retention, or urinary tract infections between cognitive groups.


      Our study revealed significant rates of cognitive impairment and sphincter misuse among men with AUS. These data suggest a role for long-term follow-up and monitoring for cognitive changes. Prospective study of cognitive decline and surgical outcomes in patients undergoing AUS is warranted.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sandhu JS
        • Breyer B
        • Comiter C
        • et al.
        Incontinence after prostate treatment: AUA/SUFU Guideline.
        J. Urol. 2019; 202: 369-378
        • Yafi FA
        • DeLay KJ
        • Stewart C
        • et al.
        Device survival after primary implantation of an artificial urinary sphincter for male stress urinary incontinence.
        J Urol. 2017; 197 (Available at:): 759-765
        • Viers BR
        • Linder BJ
        • Rivera ME
        • et al.
        Long-term quality of life andfunctional outcomes among primary and secondary artificial urinary sphincter implantations in men with stress urinary incontinence.
        J. Urol. 2016; 196 (Available at:): 838-843
        • Van Der Aa F
        • Drake MJ
        • Kasyan GR
        • et al.
        The artificial urinary sphincter after a quarter of a century: A critical systematic review of its use in male non-neurogenic incontinence.
        Eur. Urol. 2013; 63: 681-689
        • Linder BJ
        • Rivera ME
        • Ziegelmann MJ
        • et al.
        Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at Mayo Clinic.
        Urology. 2015; 86 (Available at:): 602-607
        • Lavi A
        • Boone TB
        • Cohen M
        • et al.
        The patient beyond the sphincter–cognitive and functional considerations affecting the natural history of artificial urinary sphincters.
        Urology. 2020; 137: 14-18
        • Harada CN
        • Natelson Love MC
        • Triebel K
        Normal cognitive aging. Public access.
        Clin. Geriatr. Med. 2013; 29: 737-752
        • Hugo J
        • Ganguli M
        Dementia and cognitive impairment. Epidemiology, diagnosis, and treatment.
        Clin Geriatr Med. 2014; 30: 421-442
        • Mograbi DC
        • Morris RG
        • Fichman HC
        • et al.
        The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country.
        Int J Geriatr Psychiatry. 2018; 33: 807-813
        • Greiner PA
        • Snowdon DA
        • Schmitt FA
        The loss of independence in activities of daily living: The role of low normal cognitive function in elderly nuns.
        Am J Public Health. 1996; 86: 62-66
        • Newkirk LA
        • Kim JM
        • Thompson JM
        • et al.
        Validation of a 26-point telephone version of the mini-mental state examination.
        J Geriatr Psychiatry Neurol. 2004; 17: 81-87
        • Folstein MF
        • Folstein SE
        • McHugh PR
        Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Tombaugh T
        • Mcintyre N
        The mini-mental state examination: a comprehensive review.
        J Am Geriatr Soc. 1992; 40: 922-935
        • Creavin ST
        • Wisniewski S
        • Noel-Storr AH
        • et al.
        Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations.
        Cochrane Database Syst Rev. 2016; 13: CD011145
        • Uren AD
        • Cotterill N
        • Parke SE
        • et al.
        Psychometric equivalence of electronic and telephone completion of the ICIQ modules.
        Neurourol Urodyn. 2017; 36: 1342-1349
        • Medendorp AR
        • Anger JT
        • Jin C
        • et al.
        The impact of frailty on artificial urinary sphincter placement and removal procedures.
        Urology. 2019; 129: 210-216
        • O'Connor RC
        • Nanigian DK
        • Patel BN
        • et al.
        Artificial urinary sphincter placement in elderly men.
        Urology. 2007; 69: 126-128
        • Léon P
        • Chartier-Kastler E
        • Rouprêt M
        • et al.
        Long-term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence.
        BJU Int. 2015; 115: 951-957
        • Raup VT
        • Eswara JR
        • Marshall SD
        • et al.
        Artificial urinary sphincters for treatment of urinary incontinence in elderly males.
        Urol Int. 2016; 97: 200-204
        • Wolski Z
        • Tworkiewicz M
        • Szabela-Polak A
        Psychological aspect of qualification to implant an artificial urethral sphincter AMS 800.
        Cent Eur J Urol. 2012; 65: 21-23
        • Petersen RC
        Mild cognitive impairment. Contin. lifelong learn.
        Neurol. 2016; 22: 404-418
        • Ziegelmann MJ
        • Linder BJ
        • Rivera ME
        • et al.
        Outcomes of artificial urinary sphincter placement in octogenarians.
        Int J Urol. 2016; 23: 419-423
        • Keles A
        • Onur R
        • Aydos M
        • et al.
        The role of educational level and cognitive status in men undergoing artificial urinary sphincter implantation.
        Urology. 2020; (Epub ahead of print)
        • Hughes ML
        • Agrigoroaei S
        • Jeon M
        • Bruzzese M
        • Lachman ME
        Change in cognitive performance from midlife into old age: findings from the midlife in the United States (MIDUS) Study.
        J Int Neuropsychol Soc. 2018; 24: 805-820