PD49-11 IS THE GOLD STANDARD SHIFTING? NATIONAL TRENDS IN ANTI-INCONTINENCE SURGERY FOR MEN BASED ON THE NATIONAL INPATIENT SAMPLE

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II1 Apr 2016PD49-11 IS THE GOLD STANDARD SHIFTING? NATIONAL TRENDS IN ANTI-INCONTINENCE SURGERY FOR MEN BASED ON THE NATIONAL INPATIENT SAMPLE Susan MacDonald, Marc Colaco, and Ryan Terlecki Susan MacDonaldSusan MacDonald More articles by this author , Marc ColacoMarc Colaco More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) threatens the quality of life for men after prostate surgery, most commonly radical prostatectomy. The gold standard of surgical management has traditionally been the artificial urinary sphincter (AUS). Alternatively the male sling is typically reserved for men with lesser degrees of incontinence. Refinements in instrumentation and technique related to prostate surgery may reduce the incidence and degree of subsequent SUI. We sought to determine the national trend in surgical management of male SUI in context of the rate of radical prostatectomy. METHODS A retrospective cross sectional analysis was performed using data collected in the National Inpatient Survey (NIS) database. Cases were identified by their ICD-9 procedure codes. For the purpose of identifying incontinence procedures we queried the codes 589.3 (implantation of artificial urinary sphincter [AUS]), 59.4 (suprapubic sling operation), 59.5 (retropubic urethral suspension), and 59.6 (paraurethral suspension) for incontinence procedures. We also queried the database for cases of radical prostatectomy (ICD-9 code 60.5) for comparison. All data was collected for the time period from January 2000 through December 2012. Data was weighted to a national average using NIS guidelines. RESULTS 32,416 men underwent anti-incontinence surgery from 2000-2012, with 20,790 AUS and 11,625 sling procedures. Over the study period there was a significant downward trend in the number of total incontinence procedures performed (F(1,11)=6.15, p= 0.03). However, when stratifying the data by type of procedure, only AUS placement showed a significant decline (F(1,11)=21.70, p<0.01) while sling procedures demonstrated a significant increase (F(1,11)=12.95, p<0.01). There was no significant change in the number of radical prostatectomies. CONCLUSIONS The rate of anti-incontinence surgery for men is decreasing nationally. As it relates to the type of procedure, AUS placement is becoming significantly less common while sling placement is becoming significantly more common. Future work will determine if the trends are related to improved outcomes following prostate surgery, changes in reimbursement for prosthetic urology, or changes in patient and/or surgeon preference. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1184-e1185 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Susan MacDonald More articles by this author Marc Colaco More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...