Vol. 46 (4): 632-639, July – August, 2020
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
1 Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany; 2 University Medical Center of Johannes-Gutenberg University, Mainz, Germany; 3 Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany; 4 Department of Urology, Vivantes Hospital Berlin, Berlin, Germany; 5 Department of Urology, Helios Hospital DuisburgDuisburg, Germany; 6 Department of Pediatric Urology, Helios Hospital DuisburgDuisburg, Germany; 7 Department of Surgery, Urology University Hospital Southampton NHS Foundation Trust, Hampshire, United Kingdom; 8 Department of Urology, University Hospital Southampton NHS Foundation Trust, Hampshire, United Kingdom; 9 Department of Urology, University Hospital Muenster, Muenster, Deutschland; 10 Klinik für Urologie und Kinderurologie. Marienhausklinikum Bendorf-Neuwied-Waldbreitbach, Germany; 11 Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; 12 Department of Urology, Diakonie Hospital Schwäbisch Hall, Schwäbisch Hall, Germany
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: Urinary Incontinence, Stress; Urinary Sphincter, Artificial; Quality of Life