title: The Impact of Diabetes Mellitus and Obesity on Artificial Urinary Sphincter Outcomes in Men.
abstract: OBJECTIVE
  To evaluate the impact of diabetes and obesity on artificial urinary sphincter (AUS) outcomes.
  
  
  METHODS
  From 1987 to 2011, men with available diabetes and body mass index (BMI) information (568 of 954) undergoing primary AUS placement at our institution were evaluated. The incidence of all-cause reintervention, mechanical failure, atrophy, and erosion or infection was assessed using the Kaplan-Meier method. Multivariable analyses evaluated the association between clinical characteristics and AUS outcomes.
  
  
  RESULTS
  In total, 90 (16%) men had diabetes. Median follow-up among alive men without AUS event was 5.9 years. Diabetics had a greater 5-year incidence of erosion/infection (13% vs 8%; P = .025). On multivariable analysis, diabetes was independently associated with an increased risk of erosion/infection (hazard ratio [HR] = 2.26; P = .02); whereas greater BMI was associated with a reduced risk of erosion or infection (obese: HR = 0.39; P = .02; overweight: HR = 0.57; P = .07). Accordingly, in diabetics, greater average postoperative glucose level (176 mg/dL vs 153 mg/dL; P = .04) and use of nonantibiotic coated devices (13 of 62 vs 1 of 28; P = .035) was associated with a greater incidence of erosion or infection. There was no difference in social continence (≤1 pad/day) (45% vs 57%; P = .29) or high-level satisfaction (95% vs 90%; P = .43) among diabetics vs nondiabetics. However, with greater BMI (<25, 25 to <30, and ≥30), there was a decrease in ≤1 pad/day usage (62% vs 61% vs 49%; P = .02).
  
  
  CONCLUSIONS
  We found that the presence of diabetes was independently associated with a 2.3-fold increased risk of AUS erosion or infection. These findings warrant the consideration of additional periprocedural measures to reduce the risk of this devastating complication.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Boyd R
authors.initials: BR
authors.lastname: Viers
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Linder
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Marcelino E
authors.initials: ME
authors.lastname: Rivera
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Jack R
authors.initials: JR
authors.lastname: Andrews
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Rangel
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ziegelmann
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: elliott.daniel@mayo.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Elliott
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D016741:Urinary Sphincter, Artificial