Int Neurourol J.
2017 Jun;21(2):109-115. 10.5213/inj.1632626.313.
Targeting Moderate and Severe Male Stress Urinary Incontinence With Adjustable Male Slings and the Perineal Artificial Urinary Sphincter: Focus on Perioperative Complications and Device Explantations
- Kretschmer A
- Hüsch T
- Thomsen F
- Kronlachner D
- Obaje A
- Anding R
- Pottek T
- Rose A
- Olianas R
- Friedl A
- Hübner W
- Homberg R
- Pfitzenmaier J
- Queissert
- Naumann CM
- Wotzka C
- Hofmann T
- Seiler R
- Haferkamp
- Bauer RM
- Debates On Male Incontinence (DOMINO)-Project
- Affiliations
-
- 1Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany. Alexander.kretschmer@med.uni-muenchen.de
- 2Department of Urology, University Medical Center of Johannes-Gutenberg University, Mainz, Germany.
- 3Department of Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany.
- 4Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany.
- 5Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany.
- 6Department of Urology, Asklepios Hospital West Hamburg, Hamburg, Germany.
- 7Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany.
- 8Department of Urology, Hospital Lueneburg, Lueneburg, Germany.
- 9Department of Urology, Hospital Göttlicher Heiland Vienna, Vienna, Austria.
- 10Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria.
- 11Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany.
- 12Department of Urology, Evangelic Hospital Bielefeld, Bielefeld, Germany.
- 13Department of Urology, University Hospital Muenster, Muenster, Deutschland.
- 14Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
- 15Department of Urology, Diakonie Hospital Stuttgart, Stuttgart, Germany.
- 16Department of Urology, Diakonie Hospital Schwäbisch Hall, Schwäbisch Hall, Germany.
- 17Department of Urology, University Hospital Bern, Bern, Switzerland.
- KMID: 2387171
- DOI: http://doi.org/10.5213/inj.1632626.313
Abstract
- PURPOSE
To analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort.
METHODS
Two hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n=127 adjustable male sling [n=95 Argus classic, n=32 Argus T], n=155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P<0.05).
RESULTS
We found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P=0.003). The most frequent intraoperative complication was bladder perforation (n=17). Postoperative infection rates did not vary significantly between the respective devices (P=0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P=0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556; P=0.001).
CONCLUSIONS
Complication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival.
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