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Risk factors for artificial urinary sphincter failure

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Abstract

Purpose

To analyze revision rates and risk factors for artificial urinary sphincter failure.

Methods

Eighty-four patients underwent implantation of an artificial urinary sphincter in one reference center. Continence rates were defined by daily pad usage. Influence of predefined risk factors for device explantation, revision, differences in preoperative pad usage, and device survival was analyzed using Chi-squared test, Wilcoxon signed-rank test, and Kaplan–Meier analysis. A multivariate analysis was performed using a logistic regression model. A p value below 0.05 was considered statistically significant.

Results

After a mean follow-up of 39.7 months, the device was still in situ in 64 patients. In univariate analysis, perioperative need of anticoagulation led to a significant increase in urethral erosion (6 vs. 30 %; p = 0.002) and explantation rate (15 vs. 34 %; p = 0.047). Pelvic irradiation increased postoperative infection rates significantly (0 vs. 10 %; p = 0.018). Penoscrotal approach led to significant increase in urethral erosion rate (0 vs. 21 %; p = 0.015). Implantation of a double cuff led to a significant increase in explantation rate (58 vs. 24 %; p = 0.014), revision rate (75 vs. 38 %; p = 0.017), and infection rate (17 vs. 1 %; p = 0.008). When using cuff size of 3.5 cm, revision rate (20 vs. 50 %; p = 0.026) as well as incontinence rates (40 vs. 82 %; p = 0.014) was significantly lower. In multivariate analysis, only perioperative anticoagulation and double-cuff placement were independent predictors of artificial urinary sphincter failure.

Conclusions

Our findings highlight the influence of perioperative anticoagulative therapy. In addition, the current study provides further evidence that double-cuff implantation should be performed only with caution during primary implantation.

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Abbreviations

SUI:

Stress urinary incontinence

AUS:

Artificial urinary sphincter

EAU:

European Association of Urology

ASA:

Acetylsalicylic acid

SD:

Standard deviation

PGI-1:

Patient’s global improvement score

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Author contributions

Kretschmer: Protocol/project development, data collection or management, data analysis, manuscript writing/editing. Buchner: Protocol/project development, data analysis, manuscript writing/editing. Grabbert: Protocol/project development, manuscript writing/editing. Stief: Protocol/project development, manuscript writing/editing. Pavlicek: Protocol/project development, data collection or management, data analysis. Bauer: Protocol/project development, data collection or management, data analysis, manuscript writing/editing.

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Correspondence to Alexander Kretschmer.

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Conflict of interest

A. Kretschmer, A. Buchner, M. Grabbert, C.G. Stief, and M. Pavlicek have nothing to disclose. R. M. Bauer declares consultancy work, lectures, and participation in clinical trials for AMS (Minnetonka, MN, USA).

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Kretschmer, A., Buchner, A., Grabbert, M. et al. Risk factors for artificial urinary sphincter failure. World J Urol 34, 595–602 (2016). https://doi.org/10.1007/s00345-015-1662-9

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  • DOI: https://doi.org/10.1007/s00345-015-1662-9

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