Changing Trends in Management Following Artificial Urinary Sphincter Surgery for Male Stress Urinary Incontinence: An Analysis of the National Surgical Quality Improvement Program Database

Shelton, Thomas M.; Brimley, Scott; Nguyen, Hoang Minh; Voznesensky, Igor; Khalil, Mahmoud; Machado, Bruno; Bhandari, Naleen Raj; Payakachat, Nalin; Davis, Rodney; Kamel, Mohamed H.; Raheem, Omer; Benson, Cooper

doi:10.1016/j.urology.2020.07.090

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Currently, there are no studies evaluating the timing of catheter removal following AUS placement. 14 In our study, no specific factor was identified as predictive of urinary retention on multivariable analysis. Given small number of events, wide confidence intervals were commonplace.…”

Section: Discussioncontrasting

confidence: 52%

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Kozar,

Kaylor,

Hinderscheid

et al. 2023

Journal of Urology

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Purpose:Patients may remain catheterized after artificial urinary sphincter surgery to prevent urinary retention, despite a lack of evidence to support this practice. Our study aims to evaluate the feasibility of outpatient, catheter-free continence surgery using a multi-institutional database. We hypothesize that between catheterized controls and patients without a catheter, there would be no difference in the rate of urinary retention or postoperative complications.Materials and Methods:We conducted a retrospective review of patients undergoing first-time artificial urinary sphincter placement from 2009-2021. Patients were stratified by postoperative catheter status into either no-catheter (leaving the procedure without a catheter) or catheter (postoperative indwelling catheter for ∼24 hours). The primary outcome, urinary retention, was defined as catheterization due to subjective voiding difficulty or documented postvoid residual over 250 mL.Results:Our study identified 302 catheter and 123 no-catheter patients. Twenty (6.6%) catheter and 9 (7.3%) no-catheter patients developed urinary retention (P = .8). On multivariable analysis, controlling for age, cuff size, radiation history and surgeon, there was no statistically significant association between omitting a catheter and urinary retention (OR: 0.45, 95% CI: 0.13-1.58; P = .2). Furthermore, at 30 months follow-up, Kaplan-Meier survival analysis revealed that device survival was 70% (95% CI: 62%-76%) vs 69% (95% CI: 48%-82%) for the catheter and no-catheter group, respectively.Conclusions:In our multi-institutional cohort, overall retention rates were low (7%) in groups with a catheter and without. Obviating postoperative catheterization facilitates outpatient incontinence surgery without altering reoperation over medium-term follow-up.

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Section: Discussioncontrasting

confidence: 52%

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Kozar,

Kaylor,

Hinderscheid

et al. 2023

Journal of Urology

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“…12 Other studies have confirmed increasing rates of early discharge after AUS placement, without an increase in postoperative complications. 13 One of the strengths of our study is that data collection was not limited based on inpatient status, thus capturing both ambulatory and overnight surgeries. As such, our findings did not indicate a change in AUS placement rates during the study period.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Surgical Management of Male Stress Urinary Incontinence: Data From the AUA Quality Registry

et al. 2023

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Introduction:We examined contemporary patterns in treatment of male stress urinary incontinence and identified predictors of undergoing specific surgical procedures.Methods: Utilizing the AUA Quality Registry, we identified men with stress urinary incontinence utilizing International Classification of Disease codes and related procedures for stress urinary incontinence performed from 2014 to 2020 utilizing Current Procedural Terminology codes. Characteristics of the patient, surgeon, and practice were included in a multivariate analysis of predictors of management type.Results: We identified 139,034 men with stress urinary incontinence in the AUA Quality Registry, of whom only 3.2% underwent surgical intervention during the study period. Artificial urinary sphincter was the most common procedure with 4,287/7,706 (56%) performed, followed by urethral sling with 2,368/7,706 (31%), and lastly urethral bulking with 1,040/7,706 (13%). There was no significant change by year in volume of each procedure performed during the study period. A large proportion of urethral bulking was performed by a disproportionately small number of practices; 5 high-volume practices performed 54% of the total urethral bulking over the study period. Open surgical procedure was more likely in patients with prior radical prostatectomy, urethroplasty, or care at an academic enter. Urethral bulking was more likely in patients with a history of bladder cancer or care by a surgeon of increasing age or female gender.Conclusions: Utilization of artificial urinary sphincter and urethral sling now exceeds utilization of urethral bulking for male stress urinary incontinence, though some practices continue to perform a disproportionate volume of bulking. Using data from the AUA Quality Registry, we can identify areas for quality improvement to facilitate guideline-adherent care.

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“…Shelton et al assessed 1,176 AUS male patients in the NSQIP database between 2007-2016, with 232 being categorized as early discharge (24 hours or less) and 944 being categorized as late discharge (>24 hours) (17). Operative time was shorter in the early discharge group (mean of 83 vs. 95 minutes) and early discharge cases became statistically significantly more common beginning in 2012.…”

Section: Outpatient Surgerymentioning

confidence: 99%

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review

Desai¹,

Rozanski²

2023

Transl Androl Urol

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Surgery plays a crucial role in the definitive management of male stress urinary incontinence (SUI). The most utilized and well-studied surgical options include the artificial urinary sphincter (AUS) and the male sling (MS). The AUS has long been considered the "gold standard" and more versatile option in this space, showing effectiveness in mild, moderate, and severe SUI cases, whereas the MS is preferred in cases of mild to moderate SUI. Not surprisingly, and importantly, much of the published literature on male stress incontinence has focused on determining the "ideal" candidate for each procedure and identifying which clinical, device-specific, and patient factors play an important role in the objective and subjective success rates. There are, however, more granular, and sometimes debatable, topics to assess regarding the real-life practice patterns of male SUI surgery. The aim of this clinical practice review is to examine current trends of several of these topics including: AUS vs. MS utilization, the prevalence of outpatient procedures, 3.5 cm AUS cuff use, preoperative urine studies utilization, and intraoperative and postoperative antibiotics.As with many things in surgery, dogma rather than evidence-based medicine can significantly influence everyday clinical decision making. We seek to highlight which practice patterns in male SUI surgery are changing and/or being challenged and debated.

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Changing Trends in Management Following Artificial Urinary Sphincter Surgery for Male Stress Urinary Incontinence: An Analysis of the National Surgical Quality Improvement Program Database

Cited by 5 publications

References 24 publications

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Patterns of Surgical Management of Male Stress Urinary Incontinence: Data From the AUA Quality Registry

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review

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