Vol. 46 (x): 2020 March 3.[Ahead of print]
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