Day-case artificial urinary sphincter for post-prostatectomy incontinence: A comparative pilot study.

Abstract

Implantation of an artificial urinary sphincter (AUS) to treat post-prostatectomy incontinence (PPI) has been traditionally offered with an overnight hospital stay. The aim of this prospective, comparative pilot study was to assess the feasibility and outcomes of the AUS procedure in a day-case setting. We included consecutive patients having primary or redo AUS surgery over an 18-month period. We excluded patients with previous urethral erosion of AUS, urethroplasty or high anaesthetic risk. All patients were offered day-case surgery. Patients who declined or could not have day-case surgery for logistical reasons had standard care with overnight stay and formed the control group for the study. Primary outcome was the proportion of successful same day-discharges in the day-case group. We also compared baseline characteristics, complications and continence at 1year post surgery. Twelve patients consented for day-case procedure, and 13 patients had standard overnight care. Mean age was 69.5years (range 58-79). Twenty-one patients (84%) had primary AUS, whereas 4 (16%) had a redo procedure. There were no significant differences between the groups in baseline demographics. Median number of pads/24 h was 5 in the day-case group and 4 in the overnight group. Eight of 12 patients (66.7%) in the day-case group were successfully discharged on the same day. Failed discharges were due to anaesthetic recovery (n= 2), high post-void residuals that resolved spontaneously (n= 1) and intraoperative superficial urethral injury (n= 1). All patients in the day-case group and all but one in the standard of care group were socially continent (0-1 pads) at 1year post procedure. Day-case catheter-free discharge of AUS patients is feasible and safe in selected patients with comparable continence outcomes and complication rates to those with standard overnight stays.