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 Cox-regression 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.
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 Cox-regression 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.
Authors: Emilio Sacco; Tommaso Prayer-Galetti; Francesco Pinto; Simonetta Fracalanza; Giovanni Betto; Francesco Pagano; Walter Artibani Journal: BJU Int Date: 2006-06 Impact factor: 5.588
Authors: Divya Ajay; Haijing Zhang; Shubham Gupta; John P Selph; Michael J Belsante; Aaron C Lentz; George D Webster; Andrew C Peterson Journal: J Urol Date: 2015-05-09 Impact factor: 7.450
Authors: Eva Haglind; Stefan Carlsson; Johan Stranne; Anna Wallerstedt; Ulrica Wilderäng; Thordis Thorsteinsdottir; Mikael Lagerkvist; Jan-Erik Damber; Anders Bjartell; Jonas Hugosson; Peter Wiklund; Gunnar Steineck Journal: Eur Urol Date: 2015-03-12 Impact factor: 20.096
Authors: Bradley C Gill; Mia A Swartz; John B Klein; Raymond R Rackley; Drogo K Montague; Sandip P Vasavada; Kenneth W Angermeier Journal: J Urol Date: 2010-01 Impact factor: 7.450
Authors: Fabian Queissert; Keith Rourke; Sandra Schönburg; Alessandro Giammò; Andreas Gonsior; Carmen González-Enguita; Antonio Romero; Andres J Schrader; Francisco Cruz; Francisco E Martins; Juan F Dorado; Javier C Angulo Journal: J Clin Med Date: 2021-12-24 Impact factor: 4.241
Authors: Emily M Yura; Christopher J Staniorski; Jason E Cohen; Liqi Chen; Ashima Singal; Francisco E Martins; Matthias D Hofer Journal: J Clin Med Date: 2021-12-13 Impact factor: 4.241