Longitudinal changes in patient‐reported outcomes after artificial urinary sphincter implantation

Abstract

Objective To evaluate the time course of lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation based on individual longitudinal changes of patient‐reported outcomes. Methods This retrospective study included 66 male patients with severe urinary incontinence who were treated with primary AUS implantation between 2009 and 2019. International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and International Prostate Symptom Score (IPSS) questionnaires were used to evaluate continence status and LUTS preoperatively, 1, 3, and 12 months after activation, and then annually. The annual changes in scores were calculated with a linear mixed model. Results Of the 66 patients, 63 (95%) achieved complete or social continence (number of pads used ≤1/d) at 1 month after activation. Mean preoperative ICIQ‐SF, IPSS, and IPSS‐quality of life (QOL) score were 18.9, 14.9, and 5.4, respectively; the corresponding scores at 1 month after activation were 4.5, 9.0, and 1.7 (all P < .001), respectively. During the mean follow‐up period of 36 months, the annual changes in the scores from 1 month after activation were 0.51 (P = .002), −0.30 (P = .184), and 0.19 (P < .001), respectively. As for individual IPSS items, while incomplete emptying, frequency, urgency, and weak stream improved significantly 1 month after activation, no significant changes from 1 month after activation were observed except for longitudinal deterioration of incomplete emptying score (0.08/y, P = .029). Conclusion Continence status and QOL score markedly improved by AUS implantation immediately, but deteriorated over time. Improved LUTS were maintained without a worsening trend, however.

Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy

“…AUS implantation could unveil the deterioration of LUTS due to pelvic RT that would have been masked by severe UI. While the improved LUTS (other than UI) after AUS implantation in the non‐RT group did not worsen as we previously reported, 2 LUTS of the RT group longitudinally deteriorated. Minimal clinically important differences are reported to be 2.5 in ICIQ‐SF, 17 3 in IPSS, 18 0.5 in IPSS‐QOL, 18 and 3 in OABSS 19 .…”

“…In addition, it improves various lower urinary tract symptoms (LUTS) other than UI. 2 In patients receiving salvage radiation therapy (RT) after RP, deterioration of lower urinary tract function has been reported. 3,4 While some patients receiving AUS implantation have a history of pelvic RT, especially salvage RT for biochemical recurrence after RP, the impact of prior RT on the outcomes of AUS implantation remains controversial.…”

“…AUS dramatically improves severe UI and reduced quality of life (QOL). In addition, it improves various lower urinary tract symptoms (LUTS) other than UI 2 . In patients receiving salvage radiation therapy (RT) after RP, deterioration of lower urinary tract function has been reported 3,4 .…”

“…In particular, storage symptoms might be more affected by pelvic RT than voiding symptoms, which was indicated by the significant deterioration of OABSS and VV, although no significant changes were observed in individual items of IPSS regarding storage symptoms, probably due to the small size of the cohort. One possible explanation is that RT reduces bladder compliance over time due to fibrosis of the detrusor and impairment of blood flow,20 which results in the longitudinal deterioration of storage functions and symptoms. Nevertheless, RT should not be considered as a contraindication of AUS implantation, because significant improvements of UI and QOL could not be obtained without AUS in patients with severe UI.…”