Mp03-07 Predictors of Reoperation Following Primary Artificial Urinary Sphincter Placement in a Large Institutional Database

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence (MP03)1 May 2024MP03-07 PREDICTORS OF REOPERATION FOLLOWING PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT IN A LARGE INSTITUTIONAL DATABASE Ekamjit S. Deol, Daniel S. Elliott, and Brian J. Linder Ekamjit S. DeolEkamjit S. Deol , Daniel S. ElliottDaniel S. Elliott , and Brian J. LinderBrian J. Linder View All Author Informationhttps://doi.org/10.1097/01.JU.0001009488.55564.85.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial urinary sphincter (AUS) placement is the preferred treatment for moderate to severe post-prostatectomy incontinence. Despite relatively high success rates, some patients will need repeat surgeries. In this study we sought to explore the predictors of all cause re-surgery and cause specific reoperation to aid in pre-operative risk stratification of patients. METHODS: We identified 1203 patients who underwent primary AUS placement for post-prostatectomy incontinence at our institution between 1983 and 2023. Clinical, demographic and surgical factors were assessed for an association with device reoperation endpoints including: all-cause reoperation, device infection/erosion, and mechanical failure. Follow-up was obtained via routine clinical care and mailed survey. Variables with a p value<0.15 on univariable cox proportional hazard models were then used to construct a multivariable cox model. RESULTS: Median follow-up was 4.5 years (IQR 1.25–9.21 years), including 410 patients that went on to undergo repeat surgery. Reoperation causes were infection (n=19), erosion (n=82), device malfunction (n=175), atrophy (n=106), pump malfunction (n=9), and other (n=19). Patients that underwent reoperation were younger (69.5 yrs vs 71.0 yrs, p<0.001) and less likely to have transcorporeal cuff placement (26% vs 44.2%, p<0.001). There were no differences in other comorbidities or number of prior incontinence procedures. Multivariable analyses are summarized in the attached forest plots. History of radiation therapy (HR 1.43, p=0.0028) and the use of anticoagulants (HR 0.72, p=0.009) were significantly associated with the risk of all-cause reoperation. Older age (HR 1.39, p=0.03) and radiation therapy (HR 1.74, p=0.02) were significantly associated with the risk of device infection/erosion. Patient age (HR 0.73, p=0.004), and use of anticoagulants (HR: 0.60, p=0.016) were significantly associated with the risk of device malfunction. CONCLUSIONS: Clinical factors including patient age, prior radiation therapy, congestive heart failure, anticoagulation status were associated with the risk of repeat device surgeries. Different factors were associated with the various device outcomes, highlighting the need for individualized patient counseling regarding AUS device survival. Download PPT Source of Funding: Thomas P. and Elizabeth S. Grainger Urology Fellowship Fund © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e24 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ekamjit S. Deol More articles by this author Daniel S. Elliott More articles by this author Brian J. Linder More articles by this author Expand All Advertisement PDF downloadLoading ...