S24 Complications After the Implantation of Argus Male Sling in Men With Stress Urinary Incontinence

Karaolides, Theocharis; Klapsas, V.; Bisias, S.; Fasoulis, L.; Pappas, Anastasios; Arvanitakis, T.

doi:10.1016/s1569-9056(10)61311-5

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“…The present study captured almost all post‐prostatectomy continence surgery within the English NHS. Selection of continence surgery appears to be unrelated to demographics; patients with prior radiation and severe incontinence are less likely to be offered the male sling than an AUS . Radiotherapy was also found to be associated with poorer outcomes for patients receiving a sling in this study.…”

Section: Discussionmentioning

confidence: 65%

“…Surgeon procedure volume has been shown to influence post‐surgical outcomes for other urological procedures and AUS implantation appears to be the same; patients in low‐volume centres were more likely to require removal of their sphincter and there were 4.3% more re‐admissions in the lowest‐volume providers compared to the highest. Although there were two centres above the inner confidence limit, these centres had a higher proportion of post‐radiotherapy patients; radiotherapy is known to increase complications . This may indicate that the centres in question undertake a higher proportion of complex operations.…”

Section: Discussionmentioning

confidence: 99%

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A national study of artificial urinary sphincter and male sling implantation after radical prostatectomy in England

et al. 2020

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Objectives To consider the provision of post‐radical prostatectomy (RP) continence surgery in England. Materials and Methods Patients with an Office of Population Census and Surveys Classification of Interventions and Procedures, version 4 code for an artificial urinary sphincter (AUS) or male sling between 1 January 2010 and 31 March 2018 were searched for within the Hospital Episode Statistics (HES) dataset. Those without previous RP were excluded. Multivariable logistic regressions for repeat AUS and sling procedures were built in stata. Further descriptive analysis of provision of procedures was performed. Results A total of 1414 patients had received index AUS, 10.3% of whom had undergone prior radiotherapy; their median follow‐up was 3.55 years. The sling cohort contained 816 patients; 6.7% of these had received prior radiotherapy and the median follow‐up was 3.23 years. Whilst the number of AUS devices implanted had increased each year, male slings peaked in 2014/2015. AUS redo/removal was performed in 11.2% of patients. Patients in low‐volume centres were more likely to require redo/removal (odds ratio [OR] 2.23 95% confidence interval [CI] 1.02–4.86; P = 0.045). A total of 12.0% patients with a sling progressed to AUS implantation and 1.3% had a second sling. Patients with previous radiotherapy were more likely to require a second operation (OR 2.03 95% CI 1.01–4.06; P = 0.046). Emergency re‐admissions within 30 days of index operation were 3.9% and 3.6% fewer in high‐volume centres, for AUS and slings respectively. The median time to initial continence surgery from RP was 2.8 years. Increased time from RP conferred no reduced risk of redo surgery for either procedure. Conclusion There is a volume effect for outcomes of AUS procedures, suggesting that they should only be performed in high‐volume centres. Given the known impact of incontinence on quality of life, patients should be referred sooner for post‐prostatectomy continence surgery.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%