Introduction

The artificial urinary sphincter (AUS) is the gold standard approach for mild-to-moderate postoperative stress urinary incontinence (SUI) in male patients. However, peri- and postoperative complication rates are high. There is still limited data about how perioperative features can affect the outcome after AUS implantation. In the current study, we investigate the effect of surgical procedure variations and perioperative complications on patient-centered outcomes after AUS implantation in a contemporary European multicenter cohort.

Methods

Inclusion criteria were as follows: Non-neurogenic SUI, primary implantation of AUS between 2010 and 2012 in a high-volume center (>200 previous implantations), moderate-to-severe SUI (≥3 pads). Complications were graded using the Clavien-Dindo scale. Quality of life (QOL) was assessed with the validated IQOL score; continence was assessed by the validated ICIQ-SF score and pad use. Pain was assessed with visual analog scales. Subjective satisfaction rates were retrieved. Endpoints were QOL, patient satisfaction, pain, and continence (up to 1 safety pad). Statistical analysis included Mann-Whitney-U test, Chi2 test, and Spearman rank correlation (p<0.05).

Results

105 patients [47.6% perineal approach; 52.4% penoscrotal] from 3 centers met the inclusion criteria. AUS had been explanted in 25 (23.8%), 4 (3.8) had been deceased. Questionnaires were sent to 76 patients, follow-up (FU) was available for 52 (68.4). Median FU was 38mo (25-58). Postoperative bleeding occurred in 5 (4.8), wound healing disorders (WHD) in 5 (4.8), urinary retention in 10 (9.5), and urinary tract infection (UTI) in 8 (7.6) patients. Postoperatively, median pad use was 1 (mean 1.2±1.1), median IQOL was 93 (84.8±22.5), and median ICIQ-SF was 8 (7.7±5.0). 23 (48.9) were continent. At FU, 17 (36.2) experienced pain. Satisfaction rate was 91.3%. Postoperative complications had no effect on continence success [p=0.489 (bleeding), p=0.596 (WHD), p=0.489 (urinary retention), p=0.543 (UTI)], patient satisfaction [p=0.913, 0.863, 0.913, 0.552], pain rates [p=0.389, 0.389, 0.637, 0.160], and IQOL scores [p=0.522]. Regarding the surgical procedure, duration of perioperative antibiotics prophylaxis significantly effected long-term pain rates (p=0.036), patient satisfaction rates (p=0.007), and correlated significantly with reduced IQOL scores (R=-0.531, p<0.001). Surgical approach, catheter size and indwelling time, and intraoperative complications had no significant effect on the analyzed endpoints.

Conclusions

This is the first study to analyze long-term effects of perioperative complications on favorable outcomes after AUS implantation. We show that perioperative morbidity does not lead to less favorable long-term results and therefore reassure both implanting surgeon and patient. Since duration of antibiotic prophylaxis had a negative effect on AUS outcomes, our results advocate a more restrictive use of perioperative antibiotics.

Funding

none