The impact of perioperative complications on favorable outcomes after artificial urinary sphincter implantation for post-prostatectomy incontinence

Abstract

Objective: To investigate the effect of perioperative complications involving artificial urinary sphincter (AUS) implantation on rates of explantation and continence as well as health-related quality of life (HRQOL). Materials and methods: Inclusion criteria encompassed non-neurogenic, moderateto-severe stress urinary incontinence (SUI) post radical prostatectomy and primary implantation of an AUS performed by a high-volume surgeon (>100 previous implantations). Reporting complications followed the validated Clavien-Dindo scale and Martin criteria. HRQOL was assessed by the validated IQOL score, continence by the validated ICIQ-SF score. Statistical analysis included Chi (2) test, Mann-Whitney-U test, and multivariate regression models (p <0.05). Results: 105 patients from 5 centers met the inclusion criteria. After a median followup of 38 months, explantation rates were 27.6% with a continence rate of 48.4%. In the age-adjusted multivariate analysis, perioperative urinary tract infection was confirmed as an independent predictor of postoperative explantation rates [OR 24.28, p=0.004). Salvage implantation (OR 0.114, 95% CI 0.02-0.67, p=0.016) and non-prostatectomy related incontinence (OR 0.104, 95% CI 0.02-0.74, p=0.023) were independent predictors for worse continence outcomes. Low visual analogue scale scores (OR 9.999, 95% CI 1,42-70.25, p=0.021) and ICIQ-SF scores, respectively (OR 0.674, 95% CI 0.51-0.88, p=0.004) were independent predictors for increased HRQOL ARTICLE INFO

Presenting signs and symptoms of artificial urinary sphincter cuff erosion

“…Our finding of increased risk of cuff erosion in patients with history of pelvic radiation is consistent with prior studies (5)(6)(7)(8)(9)(10)(11)(12). Supporting the concept that microvascular and histologic tissue changes after radiation negatively impact tissue integrity (25).…”

“…To date, most literature on AUS cuff erosion focuses on its risk factors. History of prior pelvic radiation has been associated with both a shorter time to and higher likelihood of cuff erosion (5)(6)(7)(8)(9)(10)(11)(12). Other implicated risk factors include hypertension (12), diabetes (13), cardiovascular disease (12,13), low testosterone (14), urethral catheter (15), penile prosthesis placement (16), prior urethral surgery (9,17,18), and prior cuff erosion (7,9,10,19,20).…”

In these difficult times of COVID-19, urologic research cannot stop: COVID-19 pandemic and reconstructive urology highlighted in International Brazilian Journal of Urology

“…Dr. Kretschemer and collegues (10) from Germany shows on page 632 a interesting study about the effect of perioperative complications involving artificial urinary sphincter (AUS) implantation on rates of explantation and continence as well as health-related quality of life (HRQOL) and concluded that postoperative infections adversely affect device survival after AUS implantation and the comparative long-term functional results and HRQOL outcomes are similar between patients with or without perioperative complications.…”