Artificial Urinary Sphincter Outperforms Sling for Moderate Male Stress Urinary Incontinence

Khouri, Roger K.; Ortiz, Nicolás; Baumgarten, Adam S.; Ward, Ellen E.; VanDyke, Maia E.; Hudak, Steven J.; Morey, Allen F.

doi:10.1016/j.urology.2020.03.028

Cited by 17 publications

(23 citation statements)

References 21 publications

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“…According to the Khouri et al . [39] study, no significant difference in the overall complication rate was observed between the two study groups. However, severe complications (Clavien–Dindo Grade IIIb) occurred only in the AUS group, in agreement with the Hoy and Rourke study [38].…”

Section: Discussionmentioning

confidence: 83%

“…Only two previous studies compared AUS with a fixed sling [38,39]. Hoy and Rourke [38] performed a retrospective study of 124 patients (76 AdVance, 48 AUS) with mild‐to‐moderate PPI and no significant differences were detected between treatments for continence outcomes and complications.…”

Section: Discussionmentioning

confidence: 99%

“…In the Khouri et al . [39] study, 114 patients implanted with AdVance and AdVanceXP slings were compared to 65 patients receiving an AMS800 because of moderate PPI (2–3 score on the Male Stress Incontinence Grading Scale). Their results agree with our present results, in that AUS was associated with a significantly higher success rate (0–1 pad/day) than RTS (80% vs 63%), although no matching procedure was used and only a quantitative pad count‐based outcome was reported.…”

Section: Discussionmentioning

confidence: 99%

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Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study

et al. 2020

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Objective To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post‐prostatectomy urinary incontinence (PPI) using propensity score‐matching analysis to enhance the validity of the comparison (Canadian Task Force classification II‐2). Patients and methods Consecutive men with moderate (3–5 pads/day) stress‐prevalent PPI were included if implanted with a RTS (TiLOOP® Male; pfm medical, Köln, Germany) or AUS (AMS800®; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow‐up. Preoperative assessment included 24‐h pad usage, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), urethrocystoscopy, and urodynamics if indicated. Propensity score‐matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least ‘much improved’ response at 12‐months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation. Results Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24‐h pad usage was four in both groups (P = 0.10), and median follow‐up was 51.2 months for AUS and 47.2 months (P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome (P < 0.001), the 0–1 pad/day rates was 94.3% vs 68.6% (P = 0.012) at 12 months, and 91.4% vs 68.6% (P = 0.034) at last follow‐up. At the last follow‐up, the median 24‐h leakage volumes, median ICIQ‐SF scores and satisfaction rates were 0 vs 15 mL (P = 0.017), 4 vs 10 (P = 0.001), and 94.3% vs 68.6% (P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re‐interventions, although Clavien–Dindo Grade III complications (n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias. Conclusion We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study

et al. 2020

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“…Nonetheless, the quality of scientific evidences supporting the use of this device is low, characterized by heterogenous data, low quality study, and lack of validated outcomes [15]. Additionally, comparative studies of the AUS versus other surgical devices are rare [16, 17]. A recent propensity score-matched analysis showed better results for the AUS than for the fixed sling for moderate SUI.…”

Section: Discussionmentioning

confidence: 99%

A Novel Artificial Urinary Sphincter (VICTO®) for the Management of Postprostatectomy Urinary Incontinence: Description of the Surgical Technique and Preliminary Results from a Multicenter Series

et al. 2021

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Aims: The objective of the study was to analyze short-term outcomes and safety profile of the newly designed artificial urinary sphincters (AUSs) VICTO® and VICTOplus®. Methods: Data from the implant of VICTO® or VICTOplus® AUSs on a series of consecutive male patients with stress urinary incontinence (SUI) following radical prostatectomy (RP) were retrospectively collected in 3 tertiary referral centers between May 2017 and December 2019. Patients were affected by moderate-severe genuine SUI (200–400 or >400 g urine leakage in 24-h pad test) refractory to conservative treatment. Outcomes were evaluated through the 24-h pad test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). Follow-up was scheduled after 3, 6, and 12 months and then when clinically needed. Nonparametric tests were applied in subgroup analyses. Results: Seventeen patients were enrolled: 8 were implanted with the VICTO® device and 9 with VICTOplus®. The median age at surgery was 69 (interquartile range (IQR) 60–75) years. The median follow-up was 15 (IQR 12–18) months. At 12 months, the dry rate was 76.4% and the social continence rate was 94%. The postoperative complication rate was 17.6%. All complications were classified as Clavien-Dindo I. No difference in terms of outcomes was observed between the VICTO® and the VICTOplus® subgroups. Conclusions: Preliminary outcomes of the VICTO® and VICTOplus® implantation are satisfactory. These devices may represent a safe and realistic solution for patients with moderate-severe SUI following RP.

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“…Other variables with no invasiveness or cost, such as demographics and general clinical data have not been shown to predict SUI severity or sling success. More invasive and expensive tests, such as sphincter pressure under contraction (SPUC) have demonstrated clinical utility (28); however, more studies on SPUC are needed to show that its benefits outweigh the costs and invasiveness. This study supports our recent findings that MSIGS is a highly practical and important variable when predicting surgical outcomes of an AUS or sling (27).…”

Section: Msigs 0-2 (Groupmentioning

confidence: 99%

Standing cough test stratification of moderate male stress urinary incontinence

Khouri

Ortiz

et al. 2021

Int. braz j urol.

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Purpose: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. Materials and Methods: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. Results: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). Conclusions: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.

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Artificial Urinary Sphincter Outperforms Sling for Moderate Male Stress Urinary Incontinence

Cited by 17 publications

References 21 publications

Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study

Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study

A Novel Artificial Urinary Sphincter (VICTO®) for the Management of Postprostatectomy Urinary Incontinence: Description of the Surgical Technique and Preliminary Results from a Multicenter Series

Standing cough test stratification of moderate male stress urinary incontinence

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