Editorial Comment

Abstract

This retrospective study provides some interesting, if not surprising findings on United States and worldwide use of the American Medical Systems, Inc. artificial urinary sphincter (AUS). A potential bias in interpretation, pointed out by the authors, is the fact that the data are based on a voluntarily filled patient information leaflet. In the study by Reynolds et al (Ref. 28 in the paper) on a much smaller cohort of patients in the United States only, the number of patient information forms (PIFs) was only 89% of the sales number for the same period. Are surgeons less likely to fill PIFs on revisions and does the rate vary between countries? These facts are unknown but may conceal an even higher revision rate. The most important message is the observation that of the implanting surgeons, 72% to 76% (depending on the country) only ever performed 1 or 2 implant procedures that we know of. Unfortunately, the authors missed an opportunity to explore the interesting question of whether the revision and complication rate was related directly to the implant experience of the individual surgeon! This would pave the way for the recommendation of a threshold number of cases per year per surgeon or institution which should be achieved to reduce morbidity and cost. International Variation in Artificial Urinary Sphincter UseUrologyVol. 80Issue 3PreviewTo analyze international trends in artificial urinary sphincter (AUS) use, indications for placement, and application by gender. Full-Text PDF ReplyUrologyVol. 80Issue 3PreviewWe thank the reviewers and acknowledge the comments above. Although we agree that a voluntarily filled patient information form does not replace prospective data collection, the database that formed the basis for this study has been vetted extensively by our group to ensure it includes the vast majority of revisions. Furthermore, we have explored the effect of individual surgeon experience on outcomes of artificial urinary sphincter (AUS) surgery, and found that as surgeons gain more experience, their complication rate (measured by rate of reoperation within 5 years) decreases significantly. Full-Text PDF