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. 2020 Jul-Aug;46(4):632-639.
doi: 10.1590/S1677-5538.IBJU.2019.0526.

The impact of perioperative complications on favorable outcomes after artificial urinary sphincter implantation for post-prostatectomy incontinence

Alexander Kretschmer  1 , Tanja Hüsch  2 , Ralf Anding  3 , Tobias Pottek  4 , Achim Rose  5   6 , Werner Struss  7   8 , Fabian Queissert  9 , Carsten M Naumann  10 , Joanne N Nyarangi-Dix  11 , Bernhard Brehmer  12 , Axel Haferkamp  2 , Ricarda M Bauer  1 ; Debates On Male Incontinence (DOMINO)-Project
Affiliations

The impact of perioperative complications on favorable outcomes after artificial urinary sphincter implantation for post-prostatectomy incontinence

Alexander Kretschmer et al. Int Braz J Urol. 2020 Jul-Aug.

Abstract

Objective: To investigate the effect of perioperative complications involving artificial urinary sphincter (AUS) implantation on rates of explantation and continence as well as health-related quality of life (HRQOL).

Materials and methods: Inclusion criteria encompassed non-neurogenic, moderate-to-severe stress urinary incontinence (SUI) post radical prostatectomy and primary implantation of an AUS performed by a high-volume surgeon (>100 previous implantations). Reporting complications followed the validated Clavien-Dindo scale and Martin criteria. HRQOL was assessed by the validated IQOL score, continence by the validated ICIQ-SF score. Statistical analysis included Chi (2) test, Mann-Whitney-U test, and multivariate regression models (p<0.05).

Results: 105 patients from 5 centers met the inclusion criteria. After a median follow-up of 38 months, explantation rates were 27.6% with a continence rate of 48.4%. In the age-adjusted multivariate analysis, perioperative urinary tract infection was confirmed as an independent predictor of postoperative explantation rates [OR 24.28, 95% CI 2.81-209.77, p=0.004). Salvage implantation (OR 0.114, 95% CI 0.02-0.67, p=0.016) and non-prostatectomy related incontinence (OR 0.104, 95% CI 0.02-0.74, p=0.023) were independent predictors for worse continence outcomes. Low visual analogue scale scores (OR 9.999, 95% CI 1,42-70.25, p=0.021) and ICIQ-SF scores, respectively (OR 0.674, 95% CI 0.51-0.88, p=0.004) were independent predictors for increased HRQOL outcomes. Perioperative complications did not significantly impact on continence and HRQOL outcomes.

Conclusion: Findings show postoperative infections adversely affect device survival after AUS implantation. However, if explantation can be avoided, the comparative long-term functional results and HRQOL outcomes are similar between patients with or without perioperative complications.

Keywords: Quality of Life; Urinary Incontinence, Stress; Urinary Sphincter, Artificial.

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Conflict of interest statement

None declared.

Comment in

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