Abstract
Purpose
Male stress urinary incontinence (SUI) can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male SUI. Our objective is to evaluate 30-day complications in patients undergoing male slings and AUS placement from a national multicenter database.
Methods
Data from the American College of Surgeons National Surgical Quality of Improvement Program for 2008–2013 were used to identify patients who underwent male slings and AUS implantation. Trained coders abstracted complication data from the patient record independent of the surgical team. We compared 30-day postoperative complications for male slings and AUS. We examined the relationship between patient factors and complication rates for each procedure type.
Results
Overall, 1205 incontinence surgeries in men were identified: 597 male sling placements and 608 AUS implantations. Male sling placement had a lower 30-day postoperative complication rate compared to AUS (2.8 vs. 5.1 %, p = 0.046). Compared to AUS, male sling was associated with fewer urinary tract infections (0.3 vs. 2.0 %, p = 0.020) and return trips to the operating room (1.0 vs. 3.0 %, p < 0.001). Patients with higher BMI were more likely to have a complication, while age, race and Charlson comorbidity index were not associated with higher or lower complication rates.
Conclusions
Complications rates for both male sling and AUS are low. Male sling is associated with a lower rate of complications than AUS. These findings allow for better patient perioperative counseling regarding 30-day perioperative complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C et al (2010) Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 29:213–240
Cornu JN, Peyrat L, Haab F (2013) Update in management of male urinary incontinence: injectables, balloons, minimally invasive approaches. Curr Opin Urol 23(6):536–539
Kim PH, Pinheiro LC, Atoria CL, Eastham JA, Sandhu JS, Elkin EB (2013) Trends in the use of incontinence procedures after radical prostatectomy: a population based analysis. J Urol 189(2):602–608
Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK et al (2012) EAU guidelines on surgical treatment of urinary incontinence. Eur Urol 62(6):1118–1129
Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN, Group YAUFU (2013) The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol 63(4):681–689
Siska VB, Frank VDA, de Ridder D (2014) Review: the use of sling versus sphincter in postprostatectomy urinary incontinence. BJU Int 116(3):330–342
Kim JC, Cho KJ (2012) Current trends in the management of post-prostatectomy incontinence. Korean J Urol 53(8):511–518
Rehder P, Haab F, Cornu JN, Gozzi C, Bauer RM (2012) Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol 62(1):140–145
de Leval J, Waltregny D (2008) The inside-out trans-obturator sling: a novel surgical technique for the treatment of male urinary incontinence. Eur Urol 54(5):1051–1065
Bauer RM, Mayer ME, May F, Gratzke C, Buchner A, Soljanik I et al (2010) Complications of the AdVance transobturator male sling in the treatment of male stress urinary incontinence. Urology 75(6):1494–1498
Linder BJ, Piotrowski JT, Ziegelmann MJ, Rivera ME, Rangel LJ, Elliott DS (2015) Perioperative complications following artificial urinary sphincter placement. J Urol 194(3):716–720
Steinberg SM, Popa MR, Michalek JA, Bethel MJ, Ellison EC (2008) Comparison of risk adjustment methodologies in surgical quality improvement. Surgery 144(4):662–667; discussion -7
Davenport DL, Henderson WG, Khuri SF, Mentzer RM, Jr. (2005) Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: a case study using the National Surgical Quality Improvement Program (NSQIP) database. Ann Surg. 242(4):463–468; discussion 8-71
Khuri SF (2005) The NSQIP: a new frontier in surgery. Ann Surg 228:491
Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251
Chughtai B, Sedrakyan A, Isaacs AJ, Mao J, Lee R, Te A et al (2014) National study of utilization of male incontinence procedures. Neurourol Urodyn 35(1):74–80
Light JK, Reynolds JC (1992) Impact of the new cuff design on reliability of the AS800 artificial urinary sphincter. J Urol 147:609–611
Kim SP, Sarmast Z, Daignault S, Faerber GJ, McGuire EJ, Latini JM (2008) Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol 179:1912–1916
Linder BJ, de Cogain M, Elliott DS (2014) Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection. J Urol 191:734–738
Lai HH, Hsu EI, Teh BS, Butler EB, Butler TB (2007) 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol 177:1021–1025
Migliari R, Pistolesi D, De Angelis M (2003) Polypropilene sling of the bulbar urethra for post-radical prostatectomy incontinence. Eur Urol 43:152–157
Romano SV, Metrebian SE, Vaz F, Muller V, D’Ancona CA, de Souza EA et al (2009) Long-term results of a phase III multicentre trial of the adjustable male sling for treating urinary incontinence after prostatectomy: minimum 3 years. Actas Urol Esp 33:309–314
Romano SV, Huebner W, Rocha FT, Vaz FP, Muller V et al (2014) A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study. Int Braz J Urol 40(6):781–789
Mascle L, Descazeaud A, Robert G, Bernhard JC, Bensadoun H, Ferrier JM et al (2015) Multicenter study of Advance ® suburethral sling for treatment of postoperative urinary incontinence of male. Prog Urol 25(5):249–255
Rehder P, Haab F, Cornu JN, Gozzi C, Bauer RM (2012) Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol 62(1):140–145
Lim B, Kim A, Song M, Chun J-Y, Park J, Choo M-S (2014) Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence. J Exerc Rehab 10(5):337–342
Acknowledgments
BNB supported by K12DK083021, California Urologic Foundation, CTSI Grant #UL1 TR000004.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
BNB is an advisor to American Medical Systems.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors. This article uses ACS-NSQIP database, in which patient data are de-identified.
Rights and permissions
About this article
Cite this article
Alwaal, A., Harris, C.R., Awad, M.A. et al. Comparison of complication rates related to male urethral slings and artificial urinary sphincters for urinary incontinence: national multi-institutional analysis of ACS-NSQIP database. Int Urol Nephrol 48, 1571–1576 (2016). https://doi.org/10.1007/s11255-016-1347-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-016-1347-3