Revision Surgery After Andrology Implantation in Australia Thirty-Year National Trends from Medicare Data (1994-2024)

Background: Artificial Urinary Sphincter (AUS) and Penile Prosthesis (PP) implantation are definitive surgical treatments for Severe Stress Urinary Incontinence (SUI) and Erectile Dysfunction (ED) respectively.Revision surgery is frequently required over time and represents an important marker of device durability and healthcare system burden.This study aims to characterise 30-year national trends in revision surgery following andrological implantation in Australia.Methods: A retrospective, population-based observational study was conducted using Australian Medicare Benefits Schedule (MBS) claims data from 1994-2024.Annual procedure counts for AUS and PP implantation, and revision/removal were extracted.Primary outcomes included annual revision volume and revision-to-total procedure ratios.Secondary outcomes included devicespecific trends, age-stratified revision burden, and Medicare benefits paid for revision surgery as a surrogate of economic impact.Results: Between 1994 and 2024, 20,355 implant-related procedures were recorded, including 5,936 revision surgeries (29.2%).AUS accounted for 7,474 procedures, with 2,418 revisions (32.4%), while PP accounted for 12,881 procedures with 3,518 revisions (27.3%).Annual AUS revision volume increased ~14-fold (CAGR 9.3%), outpacing growth in total AUS procedures (CAGR 8.7%).PP revision volume increased modestly (CAGR 3.5%).Revision burden was consistently higher for AUS than PP and increased with advancing age, exceeding 40% in men aged over 75.Medicare benefits pain for revision surgery increased ~ 6.7 fold over the study.Period, with AUS revision expenditure rising disproportionately and achieving cost parity with PP by the mid-2010s.Conclusions: Revision surgery constitutes a substantial component of andrology implant practice in Australia.Higher revision burden in AUS and older patient populations highlights important implications for patient counselling and long-term health system planning.