Prevalence of Cognitive Impairment and Sphincter Misuse Among Men With Artificial Urinary Sphincters

Ballantyne, Christopher; Sharma, Devang; Rapp, David E.; Boatman, Kimberly; Krzastek, Sarah C.; Costabile, Raymond A.

doi:10.1016/j.urology.2020.10.021

Cited by 4 publications

(6 citation statements)

References 21 publications

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“…Older age also appears to be associated with a higher risk of any complication. Previous research on AUS insertion in elderly men suggests similar surgical revision rates as the overall population, however, 20% required deactivation in one study due to poor functional status or dementia 18,19 . We identified an increased risk of 3 month complications and infection with patients admitted postoperatively, but a lower risk of revision/removal.…”

Section: Discussionmentioning

confidence: 54%

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

Sun

Callegari

Zhou

et al. 2023

Neurourology and Urodynamics

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Introduction and Objective Perioperative antimicrobial prophylaxis is crucial for prevention of prosthesis and patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for many urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) Best Practice guidelines. Methods The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, revision/removal, and associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. AUS‐related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline‐adherent antibiotics was done via chi‐squared and Kruskal–Wallis tests. A multivariable logistic mixed effects model was used to assess factors related to the odds of complication, specifically the use of guideline‐adherent versus nonadherent regimens. Results Of 9775 patients with primary AUS surgery, 4310 (44.1%) received guideline‐adherent antibiotics. The odds of guideline‐adherent regimen use increased 7.7% per year with 53.0% (830/1565) receiving guideline‐adherent antibiotics by the end of the study period. Patients with guideline‐adherent regimens had a decreased risk of any complication (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.74–0.93) and surgical revision (OR: 0.85, 95% CI: 0.74–0.96) within 3 months; however, no significant difference in infection within was noted (OR: 0.89, 95% CI: 0.68–1.17) within 3 months. Conclusions Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over the last two decades. While guideline‐adherent regimens were associated with decreased risk of any complication and surgical intervention, no significant association was found with risk of infection. Surgeons appear to be increasingly following AUA recommendations for antimicrobial prophylaxis for AUS surgery, however, further level 1 evidence should be obtained to demonstrate conclusive benefit of these regimens.

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Section: Discussionmentioning

confidence: 54%

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

Sun

Callegari

Zhou

et al. 2023

Neurourology and Urodynamics

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“…Limited study is available to inform prevalence of cognitive impairment and its impact on efficacy and outcomes longitudinally following implantation of an AUS. Ballantyne et al took a different route in their study and assessed cognition using a telephone survey in 74 men who had previously undergone AUS implantation ( 59 ). Eighteen (24%) patients met criteria for cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen (24%) patients met criteria for cognitive impairment. Patients with impaired cognition had more difficulty using their device but no differences were seen in AUS revision, erosion or failure rates or incontinence rates between patients with normal and impaired cognition ( 59 ). The authors conclude that urologists should continually monitor AUS patients who may be affected by cognitive dysfunction.…”

Section: Discussionmentioning

confidence: 99%

The impact of cognitive impairment in urologic implants: a narrative review

Bryk,

Zillioux,

Kennady

et al. 2023

Transl Androl Urol

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Background and Objective With the general population aging and thus more patients developing bothersome erectile dysfunction, stress urinary incontinence and overactive bladder, there will likely be a higher demand for three common interactive implants in urology, the penile prosthesis, artificial urinary sphincter (AUS) and sacral neuromodulation (SNM). Further, the prevalence of mild and major neurocognitive disorders (also known as mild cognitive impairment and dementia, respectively) is expected to increase. While the aforementioned urologic implants have excellent short and long term outcomes, there are also known device issues such as malfunction or misuse that may require surgical removal and/or revision. The objective of this narrative review is to describe the association of cognitive impairment and urologic implants. Methods We performed a search on PubMed between the years 1975–2023 for English language articles that reported on any type or severity of cognitive impairment and its association with penile prosthesis, AUS and/or SNM. While peer-reviewed published manuscripts were prioritized, abstracts that fit our search criteria were also included. Key Content and Findings Data assessing outcomes of patients with cognitive impairment who undergo placement of a urologic implant are limited. There is an association between AUS failure or misuse with cognitive impairment. SNM is efficacious in this population in the short term. In patients who develop dementia, an inflatable penile prosthesis can be deflated via in-office needle puncture and an AUS can be deactivated. The Memory Alteration Test, Quick Screen for Mild Cognitive Impairment and the Saint Louis University Mental Status Examination are relatively quick screening tests with good sensitivity and specificity for mild cognitive impairment. Conclusions While data on the association between urologic implants and cognitive impairment are sparse, there are tools that urologists can use to screen patients for cognitive impairment. With screening, urologists can provide appropriate preoperative counseling (including recommending against implantation) and can provide closer postoperative monitoring. Further study is required to assess which patients should be excluded from device implantation and how to properly assess for cognitive impairment in a manner that is both beneficial for the patient and convenient and efficient for a urologist.

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“…Globally speaking treatment success of AUS varies a lot depending on the definition used for “success.” When patient‐reported outcomes are taken into account most classify the implant as beneficial, but only 15% report zero pad‐use 22 . Very recent data confirm a high prevalence of cognitive impairment among AUS misusers with 31% of the patients with 75‐years mean age not cycling AUS with every void 23 …”

Section: Discussionmentioning

confidence: 99%

“…ATOMS, adjustable transobturator male system; AUS, artificial urinary sphincter misusers with 31% of the patients with 75-years mean age not cycling AUS with every void. 23 With this dark horizon ahead, it is not surprising that patients prefer slings over AUS whenever possible. 24 In particular, adjustable slings that need no manipulation to overcome cognitive and dexterity issues and offer results approaching or even overtaking those of AUS are increasingly used.…”

Section: Discussionmentioning

confidence: 99%

Artificial urinary sphincter or a second adjustable transobturator male system offer equivalent outcomes in patients whom required revision on the initial ATOMS device: An international multi‐institutional experience

Angulo

Schönburg

Giammò

et al. 2021

Neurourology and Urodynamics

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Aim: To evaluate treatment options after surgical revision of adjustable transobturator male system (ATOMS) and the results of further incontinence implantation. Materials and Methods: A retrospective multicenter study evaluating patients with surgical revision of ATOMS in academic institutions. Causes and factors affecting revision-free interval were studied and also the frequency of device explant and placement of second ATOMS or artificial urinary sphincter (AUS) at surgeon discretion. Operative results, complications (Clavien-Dindo), and efficacy (postoperative pad-test, pad-count, patient satisfaction, and patient global impression of improvement [PGI-I scale]) of each treatment option were compared. Results: Seventy-eight out of 902 patients (8.65%) with ATOMS underwent surgical revision at 4.1 ± 2.4 years mean follow-up and 75 (8.3%) were explanted. The main causes for revision included persistence of incontinence (35.9%) and scrotal port erosion (34.6%). Independent risk factors of the shortened revision-free interval were previous anti-incontinence surgery (HR, 1.83; 95% CI, 1.06-3.16; p = 0.007) and port erosion (HR, 1.83; 95% CI, 1.06-3.16; p = 0.0027). Fifty-eight (6.4%) received a second implant: 31 repeated ATOMS and 27 AUS. Operative time was longer for AUS (p = .003). The visual analog scale of pain at hospital discharge (p = 0.837) and postoperative complications (p = 0.154) were equivalent. The predominant cuff size for AUS was 4.5 cm (59.3%). Mean follow-up after the second implant was 29.1 ± 25.8 months. Postoperative efficacy of secondary treatment results favored ATOMS based on pad-test (p = 0.016), pad-count (p = 0.029), patient satisfaction (p = 0.04), and PGI-I (p = 0.025). Conclusions: ATOMS surgical revision due to different reasons generally leads to device explant. Rescue treatment is possible with ATOMS or AUS. No difference in postoperative complications was detected between secondary devices, but efficacy favors repeating ATOMS implantation.

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Prevalence of Cognitive Impairment and Sphincter Misuse Among Men With Artificial Urinary Sphincters

Cited by 4 publications

References 21 publications

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

The impact of cognitive impairment in urologic implants: a narrative review

Artificial urinary sphincter or a second adjustable transobturator male system offer equivalent outcomes in patients whom required revision on the initial ATOMS device: An international multi‐institutional experience

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