AIMS: We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries.
METHODS: All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included. Artificial urinary sphincter recipients, patients who underwent a sling operation and those receiving an injection of a bulking agent were identified with Current Procedure Terminology (CPT-4) and ICD-9 Procedure Codes.
RESULTS: The entire cohort of 1,246 patients were operated on between 2001 and 2011. 34.9% of them received an artificial urinary sphincter (AUS), 28.7% with a bulking agent, and 36.4% with a sling. There were no statistically significant differences in demographics or comorbidities between the treatment groups, except that more sling patients were obese (P = 0.006) and fewer bulk patients had diabetes (P = 0.007). There are, however, significant changes in procedures selected over time (P < 0.001). In the first year and over the entire follow-up after surgery, patients treated with bulking agents had the most subsequent interventions (40.1% and 52.9%), followed by sling (10.4% and 15.5%), and AUS (2.3% and 20%) (P < 0.001). Post-operative and 90 day complications were low.
CONCLUSIONS: All three treatments seem to be safe among Medicare beneficiaries with multiple comorbidities. The urological, infectious, and neurological complication occurrences were low.
Written by:
Chughtai B, Sedrakyan A, Isaacs AJ, Mao J, Lee R, Te A, Kaplan S. Are you the author?
Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
Reference: Neurourol Urodyn. 2014 Oct 18. Epub ahead of print.
doi: 10.1002/nau.22683
PubMed Abstract
PMID: 25327701