Prior Placement of Male Urethral Slings Can Increase the Need for Revision of Artificial Urinary Sphincters.

Matthias D Hofer,Jason E Cohen,Ashima Singal,Francisco E Martins,Emily M Yura,Liqi Chen,Christopher J Staniorski

doi:10.3390/jcm10245842

Matthias D Hofer, Jason E Cohen + Show 5 more

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https://doi.org/10.3390/jcm10245842

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Abstract

Background: Recurrent stress urinary incontinence (SUI) following male sling can be managed surgically with artificial urinary sphincter (AUS) insertion. Prior small, single-center retrospective studies have not demonstrated an association between having failed a sling procedure and worse AUS outcomes. The aim of this study was to compare outcomes of primary AUS placement in men who had or had not undergone a previous sling procedure. Methods: A retrospective review of all AUS devices implanted at a single academic center during 2000–2018 was performed. After excluding secondary AUS placements, revision and explant procedures, 135 patients were included in this study, of which 19 (14.1%) patients had undergone prior sling procedures. Results: There was no significant difference in demographic characteristics between patients undergoing AUS placement with or without a prior sling procedure. Average follow up time was 28.0 months. Prior sling was associated with shorter overall device survival, with an increased likelihood of requiring revision or replacement of the device (OR 4.2 (1.3–13.2), p = 0.015) as well as reoperation for any reason (OR 3.5 (1.2–9.9), p = 0.019). While not statistically significant, patients with a prior sling were more likely to note persistent incontinence at most recent follow up (68.8% vs. 42.7%, p = 0.10). Conclusions: Having undergone a prior sling procedure is associated with shorter device survival and need for revision or replacement surgery. When considering patients for sling procedures, patients should be counseled regarding the potential for worse AUS outcomes should they require additional anti-incontinence procedures following a failed sling.

Highlights

Male stress urinary incontinence (SUI) is associated with decreased quality of life.As a perpetual problem, it can cause considerable distress to patients
While radical prostatectomy accounts for the majority of men suffering with SUI, additional causes for male SUI include neurologic conditions, prior pelvic radiation, and prior transurethral or urethral surgeries
An estimated 5–6% of patients with post-prostatectomy SUI will need to proceed to surgical treatment of incontinence [1,2]

Summary

Introduction

Male stress urinary incontinence (SUI) is associated with decreased quality of life.As a perpetual problem, it can cause considerable distress to patients. Male stress urinary incontinence (SUI) is associated with decreased quality of life. An estimated 5–6% of patients with post-prostatectomy SUI will need to proceed to surgical treatment of incontinence [1,2]. Recurrent stress urinary incontinence (SUI) following male sling can be managed surgically with artificial urinary sphincter (AUS) insertion. Single-center retrospective studies have not demonstrated an association between having failed a sling procedure and worse AUS outcomes. After excluding secondary AUS placements, revision and explant procedures, 135 patients were included in this study, of which 19 (14.1%) patients had undergone prior sling procedures. Patients with a prior sling were more likely to note persistent incontinence at most recent follow up (68.8% vs 42.7%, p = 0.10)

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