A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery
Objective: The artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence, though evaluations of specific predictors for device outcomes are sparse. We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures. Methods: W...
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Elsevier
2021-07-01
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| Series: | Asian Journal of Urology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214388221000060 |
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| author | Kevin J. Hebert Brian J. Linder Griffin T. Morrisson Laureano Rangel Latuche Daniel S. Elliott |
| author_facet | Kevin J. Hebert Brian J. Linder Griffin T. Morrisson Laureano Rangel Latuche Daniel S. Elliott |
| author_sort | Kevin J. Hebert |
| collection | DOAJ |
| description | Objective: The artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence, though evaluations of specific predictors for device outcomes are sparse. We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures. Methods: We identified 2045 consecutive AUS surgeries at Mayo Clinic (Rochester, MN, USA) from 1983 to 2013. Of these, 1079 were primary AUS implantations and 281 were initial revision surgeries, which comprised our study group. Device survival rates, including overall and specific rates for device infection/erosion, urethral atrophy and mechanical failure, were compared between primary AUS placements versus revision surgeries. Patient follow-up was obtained through office examination, written correspondence, or telephone correspondence. Results: During the study period, 1079 (79.3%) patients had a primary AUS placement and 281 (20.7%) patients underwent a first revision surgery for mechanical failure or urethral atrophy. Patients undergoing revision surgery were found to have adverse 1- and 5-year AUS device survival on Kaplan–Meier analysis, 90% vs. 85% and 74% vs. 61%, respectively (p<0.001). Specifically, revision surgery was associated with a significantly increased cumulative incidence of explantation for device infection/urethral erosion (4.2% vs. 7.5% at 1 year; p=0.02), with similar rates of repeat surgery for mechanical failure (p=0.43) and urethral atrophy (p=0.77). Conclusions: Our findings suggest a significantly higher rate of overall device failure following revision AUS surgery, which is likely secondary to an increased rate of infection/urethral erosion events. |
| format | Article |
| id | doaj-art-b0faddbb0afb470dbcf6e944c40cb774 |
| institution | OA Journals |
| issn | 2214-3882 |
| language | English |
| publishDate | 2021-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Urology |
| spelling | doaj-art-b0faddbb0afb470dbcf6e944c40cb7742025-08-20T02:00:19ZengElsevierAsian Journal of Urology2214-38822021-07-018329830210.1016/j.ajur.2021.03.003A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgeryKevin J. Hebert0Brian J. Linder1Griffin T. Morrisson2Laureano Rangel Latuche3Daniel S. Elliott4Department of Urology, Mayo Clinic, Rochester, MN, USADepartment of Urology, Mayo Clinic, Rochester, MN, USADepartment of Urology, Mayo Clinic, Rochester, MN, USADepartment of Health Sciences Research, Mayo Clinic, Rochester, MN, USADepartment of Urology, Mayo Clinic, Rochester, MN, USA; Corresponding author.Objective: The artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence, though evaluations of specific predictors for device outcomes are sparse. We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures. Methods: We identified 2045 consecutive AUS surgeries at Mayo Clinic (Rochester, MN, USA) from 1983 to 2013. Of these, 1079 were primary AUS implantations and 281 were initial revision surgeries, which comprised our study group. Device survival rates, including overall and specific rates for device infection/erosion, urethral atrophy and mechanical failure, were compared between primary AUS placements versus revision surgeries. Patient follow-up was obtained through office examination, written correspondence, or telephone correspondence. Results: During the study period, 1079 (79.3%) patients had a primary AUS placement and 281 (20.7%) patients underwent a first revision surgery for mechanical failure or urethral atrophy. Patients undergoing revision surgery were found to have adverse 1- and 5-year AUS device survival on Kaplan–Meier analysis, 90% vs. 85% and 74% vs. 61%, respectively (p<0.001). Specifically, revision surgery was associated with a significantly increased cumulative incidence of explantation for device infection/urethral erosion (4.2% vs. 7.5% at 1 year; p=0.02), with similar rates of repeat surgery for mechanical failure (p=0.43) and urethral atrophy (p=0.77). Conclusions: Our findings suggest a significantly higher rate of overall device failure following revision AUS surgery, which is likely secondary to an increased rate of infection/urethral erosion events.http://www.sciencedirect.com/science/article/pii/S2214388221000060Artificial urinary sphincterOutcomesRevisionUrinary incontinenceUrethraPost prostatectomy incontinence |
| spellingShingle | Kevin J. Hebert Brian J. Linder Griffin T. Morrisson Laureano Rangel Latuche Daniel S. Elliott A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery Asian Journal of Urology Artificial urinary sphincter Outcomes Revision Urinary incontinence Urethra Post prostatectomy incontinence |
| title | A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery |
| title_full | A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery |
| title_fullStr | A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery |
| title_full_unstemmed | A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery |
| title_short | A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery |
| title_sort | comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery |
| topic | Artificial urinary sphincter Outcomes Revision Urinary incontinence Urethra Post prostatectomy incontinence |
| url | http://www.sciencedirect.com/science/article/pii/S2214388221000060 |
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