Complications and Interventions in Patients with an Artificial Urinary Sphincter: Long-Term Results

Autor: Sender Herschorn, Christopher J.D. Wallis, Sidney B. Radomski, Vladimir Ruzhynsky
Rok vydání: 2018
Předmět:
Adult
Male
Reoperation
medicine.medical_specialty
Time Factors
Urologic Surgical Procedures
Male
Urinary Incontinence
Stress
Urology
030232 urology & nephrology
Psychological intervention
Urinary incontinence
Comorbidity
Artificial urinary sphincter
Young Adult
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
medicine
Humans
Cumulative incidence
Device Removal
Aged
Retrospective Studies
Aged
80 and over
Ontario
Prostatectomy
Urinary bladder
Proportional hazards model
business.industry
Incidence
Urethral sphincter
Prostatic Neoplasms
Retrospective cohort study
Middle Aged
Prosthesis Failure
Surgery
Treatment Outcome
medicine.anatomical_structure
030220 oncology & carcinogenesis
Urinary Sphincter
Artificial
Radiotherapy
Adjuvant
medicine.symptom
business
Follow-Up Studies
Zdroj: Journal of Urology. 200:1093-1098
ISSN: 1527-3792
0022-5347
DOI: 10.1016/j.juro.2018.05.143
Popis: The artificial urinary sphincter is a common treatment of male urinary incontinence. We sought to characterize long-term rates of artificial urinary sphincter revision/removal and reimplantation, and associated risk factors.We performed a population based, retrospective study using the Ontario Health Insurance Plan database of all male patients who underwent artificial urinary sphincter implantation from 1994 to 2013. Hospital, diagnostic and billing codes were used to identify patients. The Kaplan-Meier method and multivariable Cox proportional hazards models were applied to examine the cumulative incidence of artificial urinary sphincter reimplantation and revision/removal, and identify risk factors, respectively.A total of 1,632 male patients underwent initial implantation of an artificial urinary sphincter. The 10-year revision/removal and reimplantation rates were 34% and 27%, respectively. There was no difference between high and low volume hospitals or between community and academic hospitals in terms of revision/removal. A high level of comorbidity was associated with an increasing risk of removal/revision. The reimplantation rate was significantly lower in patients who underwent insertion at hospitals with the highest volume of surgery (HR 0.55, 95% CI 0.37-0.82, p0.01). A high level of comorbidity was not associated with an increasing risk of reimplantation. Preimplantation radiotherapy was not significantly associated with the risk of reimplantation (p = 0.17) or revision/removal (p = 0.95). Other factors were not significantly associated with reimplantation or revision/removal.Most men who undergo artificial urinary sphincter placement still have a device without repeat surgery 10 years following insertion. Radiotherapy does not increase the risk of repeat surgery. A high level of comorbidity was associated with an increasing risk of removal/revision.
Databáze: OpenAIRE
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