Comparison of complication rates related to male urethral slings and artificial urinary sphincters for urinary incontinence: national multi-institutional analysis of ACS-NSQIP database

Alwaal, Amjad; Harris, Catherine R.; Awad, Mohannad A.; Allen, Isabel Elaine; Breyer, Benjamin N.

doi:10.1007/s11255-016-1347-3

Cited by 27 publications

(15 citation statements)

References 27 publications

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“…[3][4][5][6][7][8] Though overall success rates and satisfaction are high, the AUS is a procedure with many known potential complications. 5,9 Among the most severe of these complications are device infection and erosion, necessitating removal of the device in its entirety. 10 Known risk factors for device removal include diabetes, history of radiation or urethral stricture, 11 and higher American Society of Anesthesiologists (ASA) class.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

Medendorp

Anger

Jin

et al. 2019

Urology

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Objectives: To determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS) placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure. Methods: This is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006-2013. Frailty was quantified using the NSQIP-FI (Frailty Index) and was applied to logistic regression models predicting 30-day complications (overall, major and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure). Results: We identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% CI 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% CI 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, p<0.01). Conclusions: Men undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.

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Section: Introductionmentioning

confidence: 99%

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

Medendorp

Anger

Jin

et al. 2019

Urology

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“…In one of the few studies to examine whether obesity had an impact on 30-day complications following male sling, Alwaal et al reported that men with a BMI of 40 or higher had a 12% incidence of 30-day complications compared with less than 4% of patients with a BMI of less than 40. 8 While there are overall low numbers in this study, it certainly lends credence to the subjective concerns of urologists performing surgery on morbidly obese patients. In addition, Sacco et al reported that patients with a BMI of 30 or higher and those with prior radiation experienced a higher incidence of failure within 6 months of surgery.…”

Section: Discussionmentioning

confidence: 64%

Impact of obesity on male urethral sling outcomes

Monn

Jarvis

Gardner

et al. 2020

Therapeutic Advances in Urology

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Background: The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use. Methods: A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed. Results: A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min ( p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily ( p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement. Conclusion: Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.

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“…The MS is an attractive alternative for patients who wish to avoid mechanical handling during urinary voiding and intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. Furthermore, published literature supports that MS has lower complications rates than AUS (74). Nonetheless, the AMS 800 device remains the standard of treatment for complete continence and has the longest efficacy and safety records.…”

Section: Discussionmentioning

confidence: 96%

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

Chung¹

2017

Transl. Androl. Urol.

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Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.

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Comparison of complication rates related to male urethral slings and artificial urinary sphincters for urinary incontinence: national multi-institutional analysis of ACS-NSQIP database

Cited by 27 publications

References 27 publications

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

Impact of obesity on male urethral sling outcomes

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery

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