Artificial urethral sphincter (AUS) implantation remains the gold standard for managing male stress urinary incontinence, while mechanical failure continues to be a major limitation affecting long-term device durability. We report an 89-year-old man who underwent AUS reimplantation due to device malfunction. The original AUS had been implanted for 25 years in 2000 and had been dysfunctioned since 2016.

Initially, a transverse suprapubic incision and a midline vertical perineal incision were made. A Scott ring retractor was used at the perineal wound to expose the proximal bulbar urethra. The old bulbar urethral cuff was dissected out and removed. Through the suprapubic incision, dissection was carried out to remove the old pressure regulating balloon and control pump. Subsequently, the new pressure regulating balloon was positioned deep within the rectus abdominis muscle, and the new cuff was then positioned around the bulbar urethra. Finally, the control pump was tunneled from the suprapubic wound and implanted into the right scrotum. Urethrocystoscopy showed adequate coaptation of the external urethral sphincter with the artificial urethral sphincter (size 4.5 cm).

The operative time was 3 hours and 22 minutes, with minimal blood loss. Intraoperatively, crystalline deposits were identified surrounding the old bulbar urethral cuff and control pump, while a leakage hole was noticed at the pressure regulating balloon. No obvious complications were noticed intraoperatively or post-operatively. No urinary incontinence was noted after AUS reimplantation.

We presented a rare case of AUS reimplantation 25 years after initial implantation and 9 years of dysfunction, with intraoperative findings suggesting crystalline deposits around the bulbar urethra cuff and control pump as a potential contributing factor to mechanical failure.