Evaluating the Impact of Centralizing Artificial Urinary Sphincter Implantation Services in France: A National Population-Based Model on Travel Times, Equity, and Patient Outcomes

Purpose

Higher annual center volume for artificial urinary sphincter (AUS) implantation is associated with improved survival without device removal. We assessed the impact of four centralization scenarios on AUS removal rates, patient travel burden, and workload redistribution to inform healthcare policy. Materials and Methods: We conducted a national, population-based cohort study using the Observapur database, which includes all men in France treated for prostate cancer or benign prostatic hyperplasia who underwent their first AUS implantation between 2006 and 2018. Patients were identified using reimbursement codes; 7,776 had complete geographic data. We modeled four centralization scenarios: (A) closure of very low-volume centers (<1 AUS procedure/year); (B) closure of low-volume centers (<5 procedures/year); (C) closure of centers performing <10 procedures/year with reallocation to high-volume centers (>20 procedures/year); and (D) closure of centers with the highest AUS removal rates. The primary outcome was the predicted 1- and 2-year AUS removal rate. Secondary outcomes included changes in travel distances and workload redistribution.