title: National study of utilization of male incontinence procedures.
abstract: OBJECTIVE
  We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries.
  
  
  METHODS
  All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included. Artificial urinary sphincter recipients, patients who underwent a sling operation and those receiving an injection of a bulking agent were identified with Current Procedure Terminology (CPT-4) and ICD-9 Procedure Codes.
  
  
  RESULTS
  The entire cohort of 1,246 patients were operated on between 2001 and 2011. 34.9% of them received an artificial urinary sphincter (AUS), 28.7% with a bulking agent, and 36.4% with a sling. There were no statistically significant differences in demographics or comorbidities between the treatment groups, except that more sling patients were obese (P = 0.006) and fewer bulk patients had diabetes (P = 0.007). There are, however, significant changes in procedures selected over time (P < 0.001). In the first year and over the entire follow-up after surgery, patients treated with bulking agents had the most subsequent interventions (40.1% and 52.9%), followed by sling (10.4% and 15.5%), and AUS (2.3% and 20%) (P < 0.001). Post-operative and 90 day complications were low.
  
  
  CONCLUSIONS
  All three treatments seem to be safe among Medicare beneficiaries with multiple comorbidities. The urological, infectious, and neurological complication occurrences were low.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.affiliation: Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
authors.forename: Abby J
authors.initials: AJ
authors.lastname: Isaacs
authors.affiliation: Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
authors.forename: Jialin
authors.initials: J
authors.lastname: Mao
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
authors.forename: Alexis
authors.initials: A
authors.lastname: Te
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
authors.forename: Steven
authors.identifier: http://orcid.org/0000-0002-2960-9931
authors.initials: S
authors.lastname: Kaplan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D006801:Humans; D008297:Male; D006278:Medicare; D011468:Prostatectomy / Q000009:adverse effects*; D053825:Suburethral Slings; D016896:Treatment Outcome; D014481:United States; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial
keywords: Medicare; artificial urinary sphincter (AUS); male sling; post prostatectomy incontinence; urinary incontinence, stress (SUI)