title: Comparison of complication rates related to male urethral slings and artificial urinary sphincters for urinary incontinence: national multi-institutional analysis of ACS-NSQIP database.
abstract: OBJECTIVE
  Male stress urinary incontinence (SUI) can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male SUI. Our objective is to evaluate 30-day complications in patients undergoing male slings and AUS placement from a national multicenter database.
  
  
  METHODS
  Data from the American College of Surgeons National Surgical Quality of Improvement Program for 2008-2013 were used to identify patients who underwent male slings and AUS implantation. Trained coders abstracted complication data from the patient record independent of the surgical team. We compared 30-day postoperative complications for male slings and AUS. We examined the relationship between patient factors and complication rates for each procedure type.
  
  
  RESULTS
  Overall, 1205 incontinence surgeries in men were identified: 597 male sling placements and 608 AUS implantations. Male sling placement had a lower 30-day postoperative complication rate compared to AUS (2.8 vs. 5.1 %, p = 0.046). Compared to AUS, male sling was associated with fewer urinary tract infections (0.3 vs. 2.0 %, p = 0.020) and return trips to the operating room (1.0 vs. 3.0 %, p < 0.001). Patients with higher BMI were more likely to have a complication, while age, race and Charlson comorbidity index were not associated with higher or lower complication rates.
  
  
  CONCLUSIONS
  Complications rates for both male sling and AUS are low. Male sling is associated with a lower rate of complications than AUS. These findings allow for better patient perioperative counseling regarding 30-day perioperative complications.
authors.affiliation: Department of Urology, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia. amjadwal@yahoo.com.|Department of Urology, University of California San Francisco, San Francisco, CA, USA. amjadwal@yahoo.com.
authors.forename: Amjad
authors.identifier: http://orcid.org/0000-0002-7051-546X
authors.initials: A
authors.lastname: Alwaal
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Harris
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Mohannad A
authors.initials: MA
authors.lastname: Awad
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Isabel E
authors.initials: IE
authors.lastname: Allen
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000601:surgery; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods
keywords: ACS-NSQIP; Artificial urinary sphincter; Complications; Male urethral sling; Urinary incontinence