We found excellent results for repeat anterior 1-stage buccal mucosal graft urethroplasty, comparable to those of initial procedures. Patients who underwent secondary procedures were at higher risk for recurrence. However, when performed at a specialized center, the success rate was still high.

<b><i>Objectives:</i></b> The artificial urinary sphincter (AUS) is the gold standard treatment for severe stress urinary incontinence (SUI). According to the literature, patients suffering from Parkinson’s disease (PD) or stroke (ST) show adverse continence outcomes after prostate surgery and, therefore, constitute a challenging cohort for continence surgery. However, little is known with respect to the results of AUS surgery in these patients. A retrospective analysis of our institutional, prospectively maintained AUS database aims to address this aspect with a focus on surgical and functional outcomes. <b><i>Methods and Patients:</i></b> All data of patients with an AUS implantation were prospectively collected in our database since 2009. The AUS was implanted according to a standardized protocol and activated at 6 weeks postoperatively at our institution. Further follow-up (FU) consisted of pad-test, uroflowmetry, residual urine, and radiography as well as a standardized questionnaire including the Incontinence Quality of Life questionnaire (I-Quol) and International Consultation on Incontinence questionnaire (ICIQ-SF) and is scheduled at 6 and 24 months and every 2 years thereafter. Patients received a preoperative urodynamic evaluation (UD). Patients with normal voiding and storage function were considered for AUS implantation. All patients performed a preoperative test for manual dexterity. Patients with a history of ST or PD were grouped and compared to nonneurological patients. Primary/secondary endpoints of the study were complications/continence. <b><i>Results:</i></b> 234 patients were available for analysis. The median FU was 24 months (interquartile range 7–36). Twenty-four patients (10%) had a neurological history (PD and ST). Neurological patients showed significantly worse outcomes regarding continence (objective/subjective/social continence; <i>p</i> = 0.04/<i>p</i> = 0.02/<i>p</i> = 0.1). Significant differences concerning explantation rates were not observed (<i>p</i> = 1). Kaplan-Meier analysis showed no significant difference regarding explantation-free survival (log-rank <i>p</i> = 0.53). <b><i>Conclusion:</i></b> AUS implantation shows significantly worse continence rates for neurological patients, despite the fact that all patients showed normal UD results and sufficient manual dexterity. Although neurological patients showed worse outcomes for continence, AUS implantation seems to be a safe and viable treatment for patients with a history of neurological disease.

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95% CI), at 5 years 0.67 (0.56 -0.80, 95% CI). Excluding the Zumstein cohort, recurrence-free rates at 1 yr were 0.95 (0.92 -0.97, 95% CI), at 3 yrs 0.85 (0.79 -0.912, 95% CI), at 5 yrs 0.76 (0.67 -0.86, 95% CI). Zumstein study success rates were worse than the 10 other studies in the literature (p [ .05) and thus bit of an outlier.CONCLUSIONS: Despite early term success of Asopa urethroplasty, there is progressive failure over time. Intermediate term success of AU is worse then the commonly cited 5 yr success for ventral/dorsal grafting (85%). The Asopa technique in adults appears to lack durability. Further studies are needed to elucidate possible causes.