Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study

Abstract

Objective To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post‐prostatectomy urinary incontinence (PPI) using propensity score‐matching analysis to enhance the validity of the comparison (Canadian Task Force classification II‐2). Patients and methods Consecutive men with moderate (3–5 pads/day) stress‐prevalent PPI were included if implanted with a RTS (TiLOOP® Male; pfm medical, Köln, Germany) or AUS (AMS800®; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow‐up. Preoperative assessment included 24‐h pad usage, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), urethrocystoscopy, and urodynamics if indicated. Propensity score‐matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least ‘much improved’ response at 12‐months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation. Results Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24‐h pad usage was four in both groups (P = 0.10), and median follow‐up was 51.2 months for AUS and 47.2 months (P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome (P < 0.001), the 0–1 pad/day rates was 94.3% vs 68.6% (P = 0.012) at 12 months, and 91.4% vs 68.6% (P = 0.034) at last follow‐up. At the last follow‐up, the median 24‐h leakage volumes, median ICIQ‐SF scores and satisfaction rates were 0 vs 15 mL (P = 0.017), 4 vs 10 (P = 0.001), and 94.3% vs 68.6% (P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re‐interventions, although Clavien–Dindo Grade III complications (n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias. Conclusion We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes.

Artificial Urinary Sphincter Is Better Than Slings for Moderate Male Stress Urinary Incontinence With Acceptable Complication Rate: A Systematic Review and Meta-Analysis

“…Considering the inclusion and exclusion criteria for the study, 520 articles were screened and 303 full-texts were assessed carefully for eligibility. Finally, 5 eligible articles were selected in meta-analysis ( 7 – 9 , 14 , 15 ). The flow diagram of articles selection was described in Supplementary Figure 1 .…”

“…The assessment outcomes showed that most articles were well-designed and had little risk of bias. The included patients in each study differed slightly, some based on moderate daily pad use ( 9 , 14 , 15 ), while some based on moderate scale score ( 8 ). Outcome variabilities measured in studies were also found, most defining surgical success as 0–1 pad/d postoperatively.…”

“…Two main solutions are recommended for the treatment of male SUI after the failure of conservative therapy: artificial urinary sphincter (AUS) and slings. Up till now, AUS is still recognized as the gold standard for the treatment of moderate-tosevere postprostatectomy SUI, (5) for its satisfactory cure rate is usually more than 80% utilizing the strict definition of cure as 0-1 pad per day (6)(7)(8)(9)(10). However, more and more urologists put their focus on slings for the treatment of mild-to-moderate SUI, as a result of the easier procedure and avoiding an inserted prosthesis (11).…”

“…On the other hand, the patients also put a priority to slings over AUS based on their preference (12). Some studies have explored the clinical outcome of postprostatectomy SUI between AUS and slings, but the results are confusing (7)(8)(9)(10)(13)(14)(15). Hence, researches on metaanalysis is urgently needed to integrate the existing evidence to draw a conclusion about the preference of two SUI treatments mentioned above.…”

A Novel Artificial Urinary Sphincter (VICTO®) for the Management of Postprostatectomy Urinary Incontinence: Description of the Surgical Technique and Preliminary Results from a Multicenter Series

“…Nonetheless, the quality of scientific evidences supporting the use of this device is low, characterized by heterogenous data, low quality study, and lack of validated outcomes [15]. Additionally, comparative studies of the AUS versus other surgical devices are rare [16, 17]. A recent propensity score-matched analysis showed better results for the AUS than for the fixed sling for moderate SUI.…”