MP60-03 THE EFFECTIVENESS AND SAFETY OF SURGICAL PROCEDURES FOR STRESS URINARY INCONTINENCE IN PATIENTS WITH NEUROGENIC STRESS INCONTINENCE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (MP60)1 Apr 2020MP60-03 THE EFFECTIVENESS AND SAFETY OF SURGICAL PROCEDURES FOR STRESS URINARY INCONTINENCE IN PATIENTS WITH NEUROGENIC STRESS INCONTINENCE Min Soo Choo*, Bahaa Malaeb, John Park, Paholo Barboglio-Romo, J Quentin Clemens, Anne Cameron, and John T Stoffel Min Soo Choo*Min Soo Choo* More articles by this author , Bahaa MalaebBahaa Malaeb More articles by this author , John ParkJohn Park More articles by this author , Paholo Barboglio-RomoPaholo Barboglio-Romo More articles by this author , J Quentin ClemensJ Quentin Clemens More articles by this author , Anne CameronAnne Cameron More articles by this author , and John T StoffelJohn T Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000929.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated the effectiveness and safety of 3 surgical procedures (Artificial Urinary Sphincter, Suburethral Sling, Urethral Bulking agents) for treating stress urinary incontinence in patients with neurogenic lower urinary tract dysfunction. METHODS: We used CPT and ICD-9 codes between 2012 – 2019 to identify patients with neurogenic bladder dysfunction who underwent urethral bulking injection (UBI), sling, or artificial urethral sphincter (AUS) for treatment of stress urinary incontinence (SUI). Failure of procedure was defined as stress incontinence > 50% from pre operative baseline (pad number, review of symptoms) at any follow up visit and/or additional surgical intervention for SUI. Time to failure was compared between procedures and risk factors for failure assessed. RESULTS: Of the consecutive 1138 patients reviewed, 68 procedures in 51 patients (37 male) with neurogenic SUI were included. There were 39, 15, and 14 cases of UBI, sling, and AUS, respectively. The median age was 37 years (IQ: 15-56). Spinal cord injury and spina bifida were the most common diagnoses (33 patients). The median follow-up was 256 days (IQ: 108-717). AUS had the longest failure free interval, followed by sling, and UBI (Figure 1). AUS had 46% failure rate at 2700 days post implantation and sling and UBI had 50% failure rates at 760 and 369 days, respectively (log-rank, p = 0.037). Age< 19 years was a significant factor for failure of any procedure in multivariable analysis (OR 0.088, p=0.020). Failure was particularly prevalent in patients < age 19 treated with UBI (90% failure). Sex and cause of neurogenic bladder were not associated with failure. No Clavien IV-V complications were noted in any procedure and there were no differences in overall complication rates. CONCLUSIONS: Neurogenic stress incontinence can be safely treated with artificial urinary sphincter, sling or bulking agent. Artificial sphincter had the longest failure free interval and urethral bulking agents demonstrated the most rapid time to failure. Since the durability is different between each procedure, shared decision making between patient and physician is necessary to match expectations and outcomes. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e889-e890 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Min Soo Choo* More articles by this author Bahaa Malaeb More articles by this author John Park More articles by this author Paholo Barboglio-Romo More articles by this author J Quentin Clemens More articles by this author Anne Cameron More articles by this author John T Stoffel More articles by this author Expand All Advertisement PDF downloadLoading ...