Risk Factors for Failure of Male Slings and Artificial Urinary Sphincters: Results from a Large Middle European Cohort Study.
BACKGROUND
We analysed the impact of predefined risk factors: age, diabetes, history of pelvic irradiation, prior surgery for stress urinary incontinence (SUI), prior urethral stricture, additional procedure during SUI surgery, duration of incontinence, ASA-classification and cause for incontinence on failure and complications in male SUI surgery.


METHODS
We retrospectively identified 506 patients with an artificial urinary sphincter (AUS) and 513 patients with a male sling (MS) in a multicenter cohort study. Complication rates were correlated to the risk factors in univariate analysis. Subsequently, a multivariate logistic regression adjusted to the risk factors was performed. A p value <0.05 was considered statistically significant.


RESULTS
A history of pelvic irradiation was an independent risk factor for explantation in AUS (p < 0.001) and MS (p = 0.018). Moreover, prior urethral stricture (p = 0.036) and higher ASA-classification (p = 0.039) were positively correlated with explantation in univariate analysis for AUS. Urethral erosion was correlated with prior urethral stricture (p < 0.001) and a history of pelvic irradiation (p < 0.001) in AUS. Furthermore, infection was correlated with additional procedures during SUI surgery in univariate analysis (p = 0.037) in MS.


CONCLUSIONS
We first identified the correlation of higher ASA-classification and explantation in AUS. Nevertheless, only a few novel risk factors had a significant influence on the failure of MS or AUS.
University Medical Center of Johannes Gutenberg University Mainz, Department of Urology and Pediatric Urology, Mainz, Germany.
Tanja
T
Hüsch
Alexander
A
Kretschmer
Frauke
F
Thomsen
Dominik
D
Kronlachner
Martin
M
Kurosch
Alice
A
Obaje
Ralf
R
Anding
Tobias
T
Pottek
Achim
A
Rose
Roberto
R
Olianas
Alexander
A
Friedl
Wilhelm
W
Hübner
Roland
R
Homberg
Jesco
J
Pfitzenmaier
Ulrich
U
Grein
Fabian
F
Queissert
Carsten Maik
CM
Naumann
Josef
J
Schweiger
Carola
C
Wotzka
Joanne
J
Nyarangi-Dix
Torben
T
Hofmann
Kurt
K
Ulm
Ricarda M
RM
Bauer
Axel
A
Haferkamp
D000368:Aged; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005060:Europe; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects*; D013997:Time Factors; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects* / Q000295:instrumentation
Artificial urinary sphincter; Implant surgery; Male sling; Risk factor; Stress urinary incontinence