Abstract: PD29-01
Sources of Funding: University of Toronto Research Program in Functional Urology.

Introduction

The artificial urinary sphincter (AUS) is the most widely known treatment for male stress urinary incontinence. However, there are a lack of population-based data regarding rates of long-term AUS-related complications, including the need for revision/removal and reimplantation. We sought to characterize long-term rates of AUS revision/removal and reimplantation among all patients undergoing initial AUS insertion in the province of Ontario. Further, we sought to identify risk factors for these outcomes.

Methods

We conducted a population-based, retrospective cohort study of all male patients who underwent AUS implantation from 1994-2013 in Ontario, Canada, a single payer government-funded health system. Hospital procedure codes and physician billing codes were used to identify patients who had initial AUS treatment and a subsequent revision/removal, or reimplantation. The Kaplan-Meier method and multivariable Cox proportional hazards models were used to examine the cumulative incidence of AUS reimplantation and revision/removal and to identify risk factors, respectively.

Results

A total of 1632 male patients underwent implantation of AUS between 1994 and 2013. Overall, 10-year AUS reimplantation and revision/removal-free survival rates were 73.3% and 65.7%, respectively. Pre-implantation radiotherapy was not significantly associated with the risk of AUS reimplantation (p=0.17) or revision/removal (p=0.95). The risk of AUS reimplantation was significantly lower for patients who underwent AUS insertion at a hospital in the highest volume quartile of AUS surgeries (what is the quartile/yr) (Hazard Ratio (HR)=0.55, 95% CI 0.37-0.82), compared to those in the lowest quartile. Increasing comorbidity was associated with an increasing risk of AUS removal/revision (p=0.0008). Patient age at the time of implantation, region of residence, income quintile, and hospital type (academic vs. community) were not significantly associated with AUS reimplantation or revision/removal.

Conclusions

Most men who undergo AUS placement will still have a device in situ, without repeat surgeries, at 10 years following insertion. Radiotherapy does not appear to increase the risk of repeat surgeries. High volume centres have the lowest rates of reimplantation and patients with increasing morbidity have the highest risk of removal /revision. Standard clinical and epidemiologic data do not appear to predict the risk of these outcomes.

Funding

University of Toronto Research Program in Functional Urology.