PURPOSE: We assessed whether difference between intraoperative urethral circumference and artificial urinary sphincter cuff size affects postoperative outcomes.
MATERIALS AND METHODS: Medical records of 87 males who underwent implantation of an artificial urinary sphincter (AUS) between January 2006 and May 2010 were evaluated. A validated questionnaire was completed for long-term follow-up by 59 patients. The difference between urethral circumference and AUS cuff size was calculated (ΔC). Incontinence was recorded as daily pad use. The primary outcome variable was postoperative decrease in incontinence. Multivariable linear regression modeled the effect of ΔC on postoperative incontinence.
RESULTS: Mean long-term follow-up was 4.2 years. Median preoperative incontinence was 8 pads/day and median abdominal leak point pressure (ALPP) was 50 cm H2O. Median urethral circumference was 38 mm and median ΔC was 2.5 mm. Median postoperative incontinence was 1 pad/day. A 1 mm increase of ΔC resulted in a 1.6% increase in incontinence at 4.5 months post-operation (95% CI -3.1-6.2%; p=0.487). Paradoxically, every 1 mm increase of ΔC improved post-operative continence at long-term follow up by 29% (95% CI: -15-56%; p=0.162).
CONCLUSIONS: At 4.5 month follow-up there was no statistical difference in either pad utilization or patient satisfaction when ΔC was either < 4 mm or ≥4 mm. However, at long-term follow-up, the ΔC ≥4 mm group reported statistically significant better continence and satisfaction than the ΔC < 4 mm group. This study does not support efforts to improve continence by minimizing cuff size but rather suggests that modestly upsizing the cuff may produce improved long-term outcomes.
Written by:
Rothschild J, Kit LC, Seltz L, Wang L, Kaufman M, Dmochowski R, Milam DF. Are you the author?
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Reference: J Urol. 2013 Jun 29. pii: S0022-5347(13)04669-7.
doi: 10.1016/j.juro.2013.06.052
PubMed Abstract
PMID: 23820053
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