Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy

Gupta, Shubham; Ding, Laura; Granieri, Michael A.; Le, Ngoc Bich; Peterson, Andrew C.

doi:10.1002/nau.22790

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…We found a similar risk of infection but higher risk of re-intervention or complication in patients receiving AUS after urethroplasty, which had been similarly reported from a multi-institutional group based in Germany and Egypt (17). With regards to race, we note no difference in outcomes which is consistent with previous data (20), but important context includes that African American men have previously been reported to receive surgical treatment for post-prostatectomy SUI at lower rates and with longer delays after prostatectomy (22).…”

Section: Discussionsupporting

confidence: 89%

A global, propensity-score matched analysis of patients receiving artificial urinary sphincters and the risk of complications, infections, and re-interventions

Prebay¹,

Ebbott²,

Foss³

et al. 2023

Transl Androl Urol

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Background: Artificial urinary sphincters (AUS) are the gold standard treatment for patients with stress urinary incontinence. However, risk factors for implant infection, complication, or re-intervention (removal, repair, replacement) are incompletely understood. We sought to understand the impact of various patient factors on the risk of device failure by leveraging a large, multi-national research database.Methods: We queried the TriNetX database for all adult patients undergoing AUS. We evaluated the impact of age, body mass index, race, ethnicity, diabetes (DM), smoking history, history of radiation therapy (RT), history of radical prostatectomy (RP) and history of urethroplasty on select clinical outcomes. Our primary outcome was the need for re-intervention defined by current procedural terminology (CPT) codes. Secondary outcomes included overall device complication rate and infection rate defined by international classification of diseases (ICD) codes. Analytics were performed on TriNetX which calculated risk ratios (RR) and Kaplan-Meier (KM) survival. We evaluated our outcomes first on the entire population and then repeated analyses for each individual comparison cohort using the remaining demographic variables to perform propensity score matching (PSM).Results: The overall rates of AUS re-intervention, complication and infection were 23.4%, 24.1% and 6.4%, respectively. KM analysis showed median AUS survival (no need for re-intervention) at 10.6 years and projected 20-year survival probability at 31.3%. Patients with a history of smoking or urethroplasty were at higher risk of AUS complication and re-intervention. Patients with DM or a history of RT were at higher risk of AUS infection. Patients with a history of RT were at higher risk of AUS complication. All risk factors besides race showed a difference in device removal itself.Conclusions: To our knowledge, this represents the largest series to follow patients with an AUS. About one-quarter of AUS patients needed re-intervention. Multiple demographics place patients at increased risk of re-intervention, infection, or complication. These results can help guide patient selection and counseling with the goal of reducing complications.

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Section: Discussionsupporting

confidence: 89%

A global, propensity-score matched analysis of patients receiving artificial urinary sphincters and the risk of complications, infections, and re-interventions

Prebay¹,

Ebbott²,

Foss³

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

“…These findings suggest that mSUI surgery may be underutilized in older men, which is echoed by existing data; despite the known QOL improvements that mSUI surgery offers, only 3%–6% of men treated with prostatectomy undergo mSUI surgery. 17–20 This discrepancy could be due to patients themselves not seeking treatment; in a study of older community-dwelling adults with urinary incontinence, only 38% had told their physician about their incontinence. 21 Alternatively, one could hypothesize that patients may be reluctant to tell the urologist who performed their prostatectomy about their incontinence or may be concerned about having to undergo another surgery when the last surgery caused their issue to begin with.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions

et al. 2022

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Purpose: When seeking treatment for male stress urinary incontinence (mSUI), patients are faced with weighing complex risks and benefits in making treatment decisions within their individual context. We sought to quantify the frequency of decisional regret among this population and to determine factors associated with regret. Materials and Methods: A cohort of 130 males aged !65 years seen for initial mSUI consultation at the University of California, San Francisco Medical Center and the San Francisco Veterans Affairs Medical Center between June 2015 and March 2020 was developed. Using retrospective chart review and telephone interviews, we ascertained decisional regret as well as other patient-, disease-and treatment-related characteristics. Decisional regret was analyzed by treatment type and patient-, disease-and treatment-related factors. Multivariable logistic regression models were built to examine the factors most associated with decisional regret. Results: Among the entire cohort, 22% reported moderate to severe decisional regret. Regret was highest among those electing conservative management, with 34.7% having decisional regret (vs with surgery: 8.3% sling, 8.2% sphincter; p <0.001). In multivariable analysis, depression, lower rating of shared decision making and higher current incontinence scores were significantly associated with decisional regret. Conclusions: Recognition of depression, improved efforts at shared decision making and more individualized treatment counseling have the potential to improve patient satisfaction with treatment choice. In addition, given high levels of regret among those electing conservative treatment, we may be underutilizing mSUI surgery in this population.

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“…White men with cancer are more likely than minority and female patients to be treated at National Cancer Institute-Designated Comprehensive Cancer Centers, which are at the forefront of innovation and cuttingedge technologies (Sultan et al, 2015). Black patients experience a longer delay from the diagnosis to treatment and also receive fewer procedures to mitigate treatment side effects than White patients (Bustami et al, 2014;Gupta et al, 2016).…”

Section: Social Inequality In Cancer Treatment and Carementioning

confidence: 99%

Personal Mastery and the Medical, Financial, and Physical Cancer Burden: Gender and Race Differences Among Older Adults

Pudrovska

Anishkin

2020

J Aging Health

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Objectives: We explore how a new cancer diagnosis affects trajectories of personal mastery among non-Hispanic Black and White older adults. We estimate whether and how cancer therapy (chemotherapy, surgery, radiation), the amount and type of health care contacts, the financial burden, and the physical symptoms of cancer explain within- and between-gender differences in mastery. Method: Using the 2006–2014 data from the Health and Retirement Study, we apply matching and multiple regression models testing mediating and moderating effects. Results: White men experience a substantially more pronounced decline in mastery after a cancer diagnosis than all women and Black men. Cancer treatment disproportionately decreases White men’s mastery via exposure to health care settings. Discussion: Cultural norms of masculinity and femininity imbue cancer and its treatment with gender-specific meanings. Deference to medical authority and losses of independence, decision-making, and self-reliance are incompatible with masculinity and might affect mastery more adversely in older White men.

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Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy

Cited by 15 publications

References 17 publications

A global, propensity-score matched analysis of patients receiving artificial urinary sphincters and the risk of complications, infections, and re-interventions

A global, propensity-score matched analysis of patients receiving artificial urinary sphincters and the risk of complications, infections, and re-interventions

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions

Personal Mastery and the Medical, Financial, and Physical Cancer Burden: Gender and Race Differences Among Older Adults

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