Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study. (26th August 2020)

• Record Type: Journal Article
• Authors: Sacco, Emilio; Gandi, Carlo; Marino, Filippo; Totaro, Angelo; Di Gianfrancesco, Luca; Palermo, Giuseppe; Pierconti, Francesco; Racioppi, Marco; Bassi, Pierfrancesco
• Is Part Of: BJU international. Volume 127:Number 2(2021)
• Page Start: 229
• Page End: 237
• Publication Date: 2020-08-26
• Subjects: male incontinence -- radical prostatectomy -- artificial urinary sphincter -- male sling -- propensity score -- #Incontinence; Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.15197
• Languages: English
• ISSNs: 1464-4096

Abstract

Abstract : Objective: To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post‐prostatectomy urinary incontinence (PPI) using propensity score‐matching analysis to enhance the validity of the comparison (Canadian Task Force classification II‐2). Patients and methods: Consecutive men with moderate (3–5 pads/day) stress‐prevalent PPI were included if implanted with a RTS (TiLOOP ® Male; pfm medical, Köln, Germany) or AUS (AMS800 ® ; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow‐up. Preoperative assessment included 24‐h pad usage, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), urethrocystoscopy, and urodynamics if indicated. Propensity score‐matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least 'much improved' response at 12‐months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation. Results: Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24‐h pad usage was four in both groups ( P = 0.10), and median follow‐up was 51.2 months for AUS and 47.2 months ( P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome ( P < 0.001), the 0–1 pad/day rates was 94.3% vs 68.6% ( P = 0.012) at 12 months, and 91.4% vs 68.6% ( P = 0.034) at last follow‐up. At the last follow‐up, the median 24‐h leakage volumes, median ICIQ‐SF scores and satisfaction rates were 0 vs 15 mL ( P = 0.017), 4 vs 10 ( P = 0.001), and 94.3% vs 68.6% ( P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re‐interventions, although Clavien–Dindo Grade III complications ( n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias. Conclusion: We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes.