Continence and Complication Rates of Artificial Urinary Sphincter Devices (AMS 800) for Parkinson and Stroke Patients with Incontinence after Prostate Surgery: Retrospective Analysis of a Prospective Database

Objectives: The artificial urinary sphincter (AUS) is the gold standard treatment for severe stress urinary incontinence (SUI). According to the literature, patients suffering from Parkinson’s disease (PD) or stroke (ST) show adverse continence outcomes after prostate surgery and, therefore, constitute a challenging cohort for continence surgery. However, little is known with respect to the results of AUS surgery in these patients. A retrospective analysis of our institutional, prospectively maintained AUS database aims to address this aspect with a focus on surgical and functional outcomes. Methods and Patients: All data of patients with an AUS implantation were prospectively collected in our database since 2009. The AUS was implanted according to a standardized protocol and activated at 6 weeks postoperatively at our institution. Further follow-up (FU) consisted of pad-test, uroflowmetry, residual urine, and radiography as well as a standardized questionnaire including the Incontinence Quality of Life questionnaire (I-Quol) and International Consultation on Incontinence questionnaire (ICIQ-SF) and is scheduled at 6 and 24 months and every 2 years thereafter. Patients received a preoperative urodynamic evaluation (UD). Patients with normal voiding and storage function were considered for AUS implantation. All patients performed a preoperative test for manual dexterity. Patients with a history of ST or PD were grouped and compared to nonneurological patients. Primary/secondary endpoints of the study were complications/continence. Results: 234 patients were available for analysis. The median FU was 24 months (interquartile range 7–36). Twenty-four patients (10%) had a neurological history (PD and ST). Neurological patients showed significantly worse outcomes regarding continence (objective/subjective/social continence; p = 0.04/p = 0.02/p = 0.1). Significant differences concerning explantation rates were not observed (p = 1). Kaplan-Meier analysis showed no significant difference regarding explantation-free survival (log-rank p = 0.53). Conclusion: AUS implantation shows significantly worse continence rates for neurological patients, despite the fact that all patients showed normal UD results and sufficient manual dexterity. Although neurological patients showed worse outcomes for continence, AUS implantation seems to be a safe and viable treatment for patients with a history of neurological disease.

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Outcomes and complication rates of cuff-downsizing in the treatment of increasing or persisting incontinence after artificial urinary sphincter implantation: A retrospective analysis of a prospective database

European Urology ◽

10.1016/s0302-2838(21)00509-1 ◽

2021 ◽

Vol 79 ◽

pp. S168

Author(s):

S. Weis ◽

V. Maurer ◽

R. Dahlem ◽

M. Fisch ◽

T.A. Ludwig

Keyword(s):

Retrospective Analysis ◽

Artificial Urinary Sphincter ◽

Complication Rates ◽

Urinary Sphincter ◽

Prospective Database

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The impact of prior urethral sling on artificial urinary sphincter outcomes

Canadian Urological Association Journal ◽

10.5489/cuaj.3922 ◽

2016 ◽

Vol 10 (11-12) ◽

pp. 405 ◽

Cited By ~ 6

Author(s):

Matthew J. Ziegelmann ◽

Brian J. Linder ◽

Marcelino E. Rivera ◽

Boyd R. Viers ◽

Daniel S. Elliott

Keyword(s):

Retrospective Chart Review ◽

Artificial Urinary Sphincter ◽

Device Failure ◽

Kaplan Meier ◽

Hazard Ratios ◽

Urinary Sphincter ◽

Device Infection ◽

Significant Difference ◽

History Of ◽

The Impact

Introduction: We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS).Methods: We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/ erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Coxregression analysis.Results: There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy.Conclusions: AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.

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Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

Canadian Urological Association Journal ◽

10.5489/cuaj.2108 ◽

2014 ◽

Vol 8 (7-8) ◽

pp. 273 ◽

Cited By ~ 5

Author(s):

Nathan Y. Hoy ◽

Keith F. Rourke

Keyword(s):

Patient Satisfaction ◽

Artificial Urinary Sphincter ◽

Complication Rates ◽

Retrospective Comparison ◽

Urinary Sphincter ◽

Significant Difference ◽

Comorbidity Scores ◽

Clavien Grade ◽

Grade 3

Introduction: The AUS remains the gold standard treatment for post-prostatectomy incontinence (PPI), although most patients with mild-moderate PPI prefer a sling without strong evidence of procedural equivalence. This study compares outcomes of 2 procedures for the treatment of mild-moderate PPI.Methods: A retrospective review of 124 patients (76 transobturator sling, 48 AUS) with mild-moderate PPI requiring intervention over an 8-year period. The primary outcome was continence. Secondary outcomes included global patient satisfaction, improvement, and complication rates. Mild to moderate incontinence was defined as requiring ≤5 pads/day.Results: There was no significant difference in age (66.2 vs. 68.1 years; p = 0.17) or prostate cancer characteristics for slings and AUS, respectively. AUS patients had higher Charlson comorbidity scores and were more likely to have previous radiotherapy. Median length of follow up was 24 months for slings and 42 months for AUS. There was no difference in continence rates, 88.2% vs. 87.5% (p = 0.79), rate of improvement, 94.7% vs. 95.8% (p = 1.00), or patient satisfaction, 93.4% vs. 91.7% (p = 0.73), for slings and AUS, respectively. Complication rates were equivalent (19.7% vs.16.7%; p = 1.00), though a significantly higher proportion of complications with AUS were Clavien Grade 3 (0% vs. 75%; p = 0.006).Conclusions: For mild to moderate PPI there is no difference incontinence, satisfaction, or improvement rates, between AUS and slings. AUS complications tend to be more severe. Our study supports the use of slings as first-line treatment for mild-moderate PPI.

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Effects of Smoking Status on Device Survival Among Individuals Undergoing Artificial Urinary Sphincter Placement

American Journal of Men s Health ◽

10.1177/1557988316651133 ◽

2016 ◽

Vol 12 (5) ◽

pp. 1398-1402 ◽

Cited By ~ 4

Author(s):

Christina A. Godwin ◽

Brian J. Linder ◽

Marcelino E. Rivera ◽

Matthew J. Ziegelmann ◽

Daniel S. Elliott

Keyword(s):

Transient Ischemic Attack ◽

Smoking Status ◽

Univariate Analysis ◽

Artificial Urinary Sphincter ◽

Wound Complications ◽

Urinary Sphincter ◽

Significant Difference ◽

History Of ◽

Ischemic Attack ◽

The Impact

Smoking is an established risk factor for wound complications. There is limited data on the impact of smoking on artificial urinary sphincter (AUS) outcomes. Thus, the aim of this study was to assess AUS device survival outcomes based on smoking status. From 1985 to 2014, 1,270 patients underwent AUS placement with 728 having smoking status available for review. Smoking status was categorized as never, prior, and active smokers. Kaplan−Meier analysis was performed to evaluate differences in survival, including overall device and erosion/infection−free survival. Hazard regression analysis was utilized to determine the association between smoking and device outcomes. Of the 728 patients in the study, 401 had a history of smoking with 41 active smokers and 360 never smokers at the time of AUS implant. When compared with nonsmokers, past smokers had a higher rate of hypertension and prior transient ischemic attack. Clinical comorbidities were similar between nonsmokers and active smokers. On univariate analysis, patient age, history of transient ischemic attack, diabetes, and coronary artery disease were significantly associated with infection/erosion rate, but prior or active smoking statuses were not. Likewise, when comparing smokers (past or active) with lifelong nonsmokers, there was no significant difference in 1- and 5-year overall device survival. There was no evidence for adverse AUS outcomes in current or past smokers compared with nonsmokers. Given the established risk of perioperative complications secondary to smoking, the recommendation should still be to counsel patients to quit prior to undergoing AUS placement. External validation of these findings is needed.

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Improved artificial urinary sphincter outcomes using a transcorporal cuff placement in patients with a “fragile urethra”

Canadian Urological Association Journal ◽

10.5489/cuaj.6431 ◽

2020 ◽

Vol 14 (12) ◽

Author(s):

Elaine J. Redmond ◽

Keith F. Rourke ◽

Steven Tong ◽

Logan Zemp ◽

Nathan Hoy

Keyword(s):

Effective Treatment ◽

Treatment Option ◽

Artificial Urinary Sphincter ◽

Secondary Outcome ◽

Effective Treatment Option ◽

Erosion Rates ◽

Increased Risk ◽

Urinary Sphincter ◽

Significant Difference ◽

History Of

Introduction: The artificial urinary sphincter (AUS) is the most effective treatment option for incontinence after prostate cancer treatment. However, patients with a “fragile urethra” (defined as prior radiotherapy, previous failed AUS, or previous urethroplasty) are at increased risk of AUS failure. The aim of this study was to evaluate outcomes using standard and transcorporal cuff placement in this group of patients. Methods: A retrospective review was performed on patients with a fragile urethra who underwent AUS insertion between 2004 and 2017. The primary outcome was the need for AUS revision. Secondary outcome measures included change in pad use, patient satisfaction, continence (≤1 pad/day), improvement (≥50% change in pad use) and cuff erosion rates. Results: Seventy-six patients met the criteria for inclusion, with a mean age of 71.6 years and a mean followup of 37.9 months. A total of 42.1% had prior radiotherapy, 56.6% had a history of failed AUS, and 19.7% had previous urethroplasty. Transcorporal cuff placement was performed in 31.6% (n=24). These patients had lower revision (20.8% vs. 36.5%; p=0.05) and erosion rates (8.3% vs. 17.3%; p=0.09). There was no significant difference in functional outcomes such as continence (66.7% vs. 73.1%; p=0.57), improvement (100% vs. 90.4%;p=0.17), or satisfaction (82.6% vs. 69.4%; p=0.26), nor for 90-day complications (4.2% vs. 9.6%; p=0.41). Conclusions: AUS insertion is an effective treatment option for post-prostatectomy incontinence in the setting of a fragile urethra. Transcorporal cuff placement in this subset of patients may be recommended, as it is associated with lower revision and erosion rates compared to standard cuff placement.

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Quality of life and patient satisfaction after artificial urinary sphincter

Canadian Urological Association Journal ◽

10.5489/cuaj.664 ◽

2013 ◽

Vol 5 (4) ◽

pp. 268

Author(s):

Bhavneet Kahlon ◽

Richard J. Baverstock ◽

Kevin V. Carlson

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Chart Review ◽

Short Form ◽

Artificial Urinary Sphincter ◽

Complication Rates ◽

International Consultation ◽

Urinary Sphincter ◽

Patient Reported

Background: We assessed satisfaction and quality of life (QOL) inmen with artificial urinary sphincter (AUS) placement.Methods: We identified 39 men who had AUS placement. Aretrospective chart review was conducted. Validated questionnaires,including the International Consultation on IncontinenceQuestionnaire-Short Form (ICIQ-SF), Post-Operative PatientGlobal Impression of Improvement (PGI-I), Incontinence ImpactQuestionnaire-Short Form (IIQ-SF), and Urogenital Distress Index(UDI-SF), were used to measure patient-reported outcome. Globalsatisfaction was also assessed.Results: At chart review, 34 of 39 questionnaires were assessedfor QOL, satisfaction and surgical outcome. Follow-up rangedfrom 7 to 60 months (median = 24 months). Surgical revisionswere required in 6 (17.6%) patients due to infection (1), erosion(1), combined infection and erosion (1), device failure (1) andsecond cuff placement (2). Quality of life was assessed using theIIQ-SF and UDI-SF, with mean scores of 15.4 and 24.8, respectively;these scores indicated a low negative impact on QOL. TheICIQ-SF mean score was 8.2, well below the worst possible score.The number of men using more than 1 pad per day dropped from27 preoperatively to 10 postoperatively. Most patients (31/34)described their urinary condition as better, 2 had no changeand 1 was worse. Most patients (31/34, 91.2%) would be willingto undergo the procedure again, 2 were undecided, and 1would not. Similarly, 28 patients (82.4%) would recommend theprocedure to a friend, 3 respondents would “with reservation,”1 respondent was undecided, and 2 would not recommend theAUS placement.Conclusion: Treatment of urinary incontinence with the AUS hasa positive effect on QOL with high patient satisfaction and reasonablylow complication rates.

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099 The Natural History of Patients with Artificial Urinary Sphincter Cuff Erosion

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2019.01.108 ◽

2019 ◽

Vol 16 (4) ◽

pp. S51

Author(s):

J. Lucas ◽

A. Patel ◽

J. Loh-Doyle ◽

D. Nikolavsky ◽

J. Angulo ◽

...

Keyword(s):

Natural History ◽

Artificial Urinary Sphincter ◽

Urinary Sphincter ◽

History Of

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

Journal of Clinical Medicine ◽

10.3390/jcm10245842 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5842

Author(s):

Emily M. Yura ◽

Christopher J. Staniorski ◽

Jason E. Cohen ◽

Liqi Chen ◽

Ashima Singal ◽

...

Keyword(s):

Retrospective Studies ◽

Artificial Urinary Sphincter ◽

Demographic Characteristics ◽

Male Sling ◽

Sling Procedure ◽

Replacement Surgery ◽

Academic Center ◽

Urinary Sphincter ◽

Significant Difference

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.

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Mortality and long-term outcomes of palliative inotropes in ischemic and non-ischemic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehab724.0915 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Tolia ◽

M Khan ◽

S Khan ◽

D Alexander ◽

M Soltys ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Ischemic Cardiomyopathy ◽

Circulatory Support ◽

Complication Rates ◽

Number Of Patients ◽

Significant Difference ◽

History Of ◽

End Stage Heart Failure ◽

End Stage

Abstract Background Palliative inotropes are frequently utilized for symptom management in patients with end stage heart failure who are unable to undergo durable advanced heart failure therapies. With the advent of improved medical management and early intervention, palliative inotropes may allow for improved patient outcomes than seen previously. In this study, we aim to investigate the survival and outcomes of palliative inotrope therapy and its impacts on ischemic versus non-ischemic cardiomyopathy. Methods We retrospectively analyzed 220 patients with American Heart Association Stage D heart failure who were discharged with palliative inotrope therapy after January 1, 2010. Patients who underwent mechanical circulatory support (MCS) or those who underwent heart transplant were excluded. Those with a history of coronary artery disease, myocardial infarction, history of percutaneous intervention, or coronary artery bypass grafting were assigned to ischemic cardiomyopathy (ICM), while patients without these findings were assigned to non-ischemic cardiomyopathy (NICM). Statistical analysis was completed using Chi-Square and Student's t-tests, wherein p<0.05 was considered statistically significant. Results Of the 220 patients, 87 had NICM as opposed to 133 with ICM. Mean age was found to be higher among patients with ICM (70 [62–79]) compared to NICM (65 [55–72], p-value <0.01). No significant difference was seen in total days on inotrope therapy (p=0.6). While more patients in both groups were placed on milrinone as opposed to dobutamine, there was no difference between patients with ischemic and NICM (p=0.66 and 0.51 respectively). Although a greater number of patients with NICM had been lost to follow up, admitted to hospice, or expired at 2 years (p<0.01), survival at 3 months, 1 year, and 2 years showed no difference between both groups. No difference was seen in number of hospitalizations or clinic visits in one year. Both groups had similar complication rates with intravenous-access related PICC line infections and new arrhythmias. (See Table). Conclusion Despite more frequent use of durable mechanical support devices, many patients who are deemed unsuitable for invasive measures are treated with palliative inotrope therapy. We have found that there is no significant difference in survival, complications, and outcomes of patients on palliative inotropes among ischemic and NICM. These findings show the versatility of palliative inotrope therapy in end stage heart failure. Further studies with larger populations need to be evaluated. FUNDunding Acknowledgement Type of funding sources: None.

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