Background The artificial urinary sphincter (AUS) is the reference surgical treatment for moderate-to-severe post-prostatectomy stress urinary incontinence. Despite durable functional outcomes, long-term device-related morbidity and explantation remain frequent. Nationwide real-world data jointly assessing postoperative complications and determinants of revision after AUS implantation remain limited. This study aimed to provide a comprehensive national overview of postoperative complications and identify risk factors for AUS revision or explantation. Methods We conducted a retrospective nationwide cohort study using the French Programme de Médicalisation des Systèmes d’Information (PMSI). All men undergoing primary AUS implantation after radical prostatectomy between 2017 and 2019 were included and followed until December 2023. Postoperative complications were identified using International Classification of Diseases, 10th (ICD-10) Revision codes and classified according to postoperative timing. Baseline comorbidities were analysed using univariate logistic regression, while post-implantation procedures were assessed using Poisson regression to estimate incidence rate ratios for revision or explantation. Results Among 1,790 patients, 268 (15.0%) underwent AUS explantation during follow-up. Most complication-coded rehospitalisations occurred during late follow-up. Urinary incontinence–related diagnoses were the most frequent events, whereas mechanical and infectious complications represented the most clinically relevant device-related outcomes. Urethral fragility conditions were the strongest predictors of explantation. Metabolic disorders, malnutrition, prior pelvic radiotherapy, anticoagulant therapy, tobacco use, and invasive procedures—including blood transfusion, indwelling catheterisation, and cystoscopy—were significantly associated with higher revision risk. Conclusion This nationwide PMSI-based study provides a comprehensive real-world assessment of postoperative morbidity and explantation risk after AUS implantation, highlighting the importance of optimised patient selection and cautious postoperative urethral instrumentation.