The Patient Beyond the Sphincter–Cognitive and Functional Considerations Affecting the Natural History of Artificial Urinary Sphincters

Lavi, Arnon; Boone, Timothy B.; Cohen, Michael; Gross, Miki

doi:10.1016/j.urology.2019.11.031

Cited by 17 publications

(9 citation statements)

References 26 publications

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“…Good selection of one or the other device may improve the results of both. Criteria to define the best patient profile can be based on the incontinence magnitude, former irradiation, patient frailty, age, autonomy and manual dexterity [18,19]. Physicians offering different treatment options tend to consider AUS in the more complex patient [20].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

et al. 2020

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Introduction: A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented. Methods: Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated.

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Section: Discussionmentioning

confidence: 99%

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

et al. 2020

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“…Elderly people may have multiple age‐related lower urinary tract dysfunctions and conditions such as detrusor overactivity, poor compliance, or detrusor underactivity, which can coexist and contribute to the SUI. Mental health, medical comorbidities, physical status, and a supportive network can contribute to or exacerbate SUI too 18,19 . While our study did not capture a full social dataset since this was not the purpose of this study, our patient demographics showed relatively good overall health with reasonable medical comorbidities.…”

Section: Discussionmentioning

confidence: 97%

“…Mental health, medical comorbidities, physical status, and a supportive network can contribute to or exacerbate SUI too. 18 , 19 While our study did not capture a full social dataset since this was not the purpose of this study, our patient demographics showed relatively good overall health with reasonable medical comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Is artificial urinary sphincter surgery safe and effective in elderly males aged 70 years and above?

Chung

Wang²,

Cartmill

2022

LUTS

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Objectives To evaluate the clinical outcomes and patient satisfaction rate between men aged under and over 70 years who underwent artificial urinary sphincter (AUS) surgery. Methods A prospective review of all men who received AUS between January 2008 and January 2018 was undertaken with a minimum 24‐month review. All patient demographics and surgical outcomes including data on the Incontinence Impact Questionnaire, Patient Global Impression of Improvement (PGI‐I) and National Surgical Quality Improvement Program Frailty Index (NSQIP‐FI) scores, as well as patient satisfaction rates, were recorded. Results Of the 245 AUS implanted, 60 patients were aged ≥70 years with 45 virgin cases and 15 revision AUS. Reduction in mean pad use and weight over 24 hours were significant at 0.21 (0–1) pads and 8 (0–30) g in both groups with no significant difference (P = 0.76). Kaplan–Meier estimates of AUS survival showed no significant difference between men aged ≥ and <70 years at 1 year (98% versus 96%; P = 0.44). The multivariate logistic regression model showed that radiation (adjusted odds ratio [OR] 3.8, 95% CI 1.4–6.8; P < 0.01) was a significant predictor of AUS revision, while age ≥ 70 years (adjusted OR 1.0, 95% CI 0.8–8.8; P = 0.14) and frailty (NSQIP‐FI ≥ 0.27 adjusted OR 0.9, 95% CI 0.2–7.6; P = 0.82) were not. There were no significant differences in PGI‐I scores (P = 0.43) and overall satisfaction rate (83% versus 84%; P = 0.44) between the two groups. Conclusions Men aged ≥70 years reported similar clinical efficacy as men aged <70 years in terms of device survival and satisfaction rates following AUS surgery.

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“…To empty the urinary bladder, one squeezes the pump, moving fluid to the pressure-regulating balloon and allowing urine to pass out the urethra; the fluid soon passes from the pressure-regulating balloon back to the cuff to resume urethral compression and restore urinary continence. Thus, requirements to operate an AUS are manual dexterity to locate and then squeeze the pump and sufficient cognition to remember to compress the pump when preparing to urinate ( 51 ). If a patient does not have appropriate cognition to remember to cycle the device, a chronically active device can lead to urinary retention and complications thereof as well as urethral atrophy or injury.…”

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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The Patient Beyond the Sphincter–Cognitive and Functional Considerations Affecting the Natural History of Artificial Urinary Sphincters

Cited by 17 publications

References 26 publications

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

Is artificial urinary sphincter surgery safe and effective in elderly males aged 70 years and above?

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

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