Prostatic Diseases and Male Voiding Dysfunction The Role of Educational Level and Cognitive Status in Men Undergoing Artificial Urinary Sphincter Implantation Ahmet Keles, Rahmi Onur, Murat Aydos, Murat Dincer, Orhan Koca, Burhan Coskun, Abdurrahim Imamoglu, and Ahmet Karakeci OBJECTIVE To examine the relationship between education level, cognitive function of patients and the suc- cess/ revision rates of artificial urinary sphincter (AUS) implantation in men with postprostatec- tomy incontinence. METHODS Between January 2010 and March 2018, 163 patients (mean age, 68 § 6.8 years) with moderate-to-severe stress urinary incontinence who underwent AUS implantation were ret- rospectively examined. Demographic data, body mass index, comorbidities, surgical tech- nique, previous strictures, and radiation therapy were recorded. Incontinence was measured by daily pad use and evaluated by International Consultation on Incontinence Question- naire-short form. Patients’ overall improvement was assessed using the Patient Global Impression of Improvement questionnaire. Education level was determined using the Inter- national Standard Classification of Education. Cognitive status was assessed using the Mini-Mental State Examination. Treatment success was defined as the need for ≤1 pad/day at last follow-up. RESULTS AUS was successful in 77.3% of patients. The International Consultation on Incontinence Questionnaire-short form score improved significantly from 19.9 § 2.9 to 4.4 § 5.4 (P = .001). The median outcome reported subjectively on the Patient Global Impression of Improvement scale was 2.1 § 1.5 (1-7) and self-reported as “much better.” Patients’ educa- tion level had statistically no significant relationship with AUS success and revision rates. Similarly, there was no significant relationship between cognitive status, educational level and the need for revision of AUS (P >.05). However, patients with moderate cognitive impairment and a body mass index >30 showed significantly lower AUS success rates (P <.05). CONCLUSION AUS implantation is safe and effective treatment option especially for nonobese and cognitively intact patients of all educational levels. UROLOGY 00: 1-7, 2020. © 2020 Elsevier Inc. A rtificial urinary sphincter (AUS) implantation has long been considered the best surgical treat- ment option for moderate-to-severe stress urinary incontinence (SUI) in males. Most literature reports over- all success rates of ≥80% for the procedure. 1 However, a recently published study examining 1082 AUS implanta- tions with a median follow-up of 4.1 years revealed a surgi- cal revision rate of 31.3% after AUS. The most common reasons for revision were reported to be mechanical fail- ure, erosion/infection, and urethral atrophy. 2 Recently, a multitude of studies have focused on predic- tive factors for AUS implantation outcomes, in the hopes of both facilitating thorough risk stratification before sur- gery and refining treatment strategies afterwards. 3-5 Financial disclosure: The authors have no financial disclosure to report. Declaration of interest: None. From the Istanbul Esenyurt State Hospital, Department of Urology, Istanbul, Turkey; the Marmara University School of Medicine, Department of Urology, Istanbul, Turkey; the University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey; the University of Health Sciences, Bagcilar Edu- cation and Research Hospital, Department of Urology, Istanbul, Turkey; the University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Department of Urology, Istanbul, Turkey; the Uludag University School of Medicine, Department of Urology, Bursa, Turkey; the University of Health Sciences, Diskapi Training and Research Hospital, Department of Urology, Ankara, Turkey; and the Firat University School of Medicine, Department of Urology, Elazig, Turkey Address correspondence to: Ahmet Keles, Esenyurt State Hospital, Department of Urology, Istanbul, Turkey. E-mail: drkeles2009@yahoo.com Submitted: December 10, 2019, accepted (with revisions): May 6, 2020 1 https://doi.org/10.1016/j.urology.2020.05.112 0090-4295 © 2020 Elsevier Inc. All rights reserved. ARTICLE IN PRESS