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01-04-2016 | Original Article

Risk factors for artificial urinary sphincter failure

Authors: Alexander Kretschmer, Alexander Buchner, Markus Grabbert, Christian G. Stief, Micaela Pavlicek, Ricarda M. Bauer

Published in: World Journal of Urology | Issue 4/2016

Abstract

Purpose

To analyze revision rates and risk factors for artificial urinary sphincter failure.

Methods

Eighty-four patients underwent implantation of an artificial urinary sphincter in one reference center. Continence rates were defined by daily pad usage. Influence of predefined risk factors for device explantation, revision, differences in preoperative pad usage, and device survival was analyzed using Chi-squared test, Wilcoxon signed-rank test, and Kaplan–Meier analysis. A multivariate analysis was performed using a logistic regression model. A p value below 0.05 was considered statistically significant.

Results

After a mean follow-up of 39.7 months, the device was still in situ in 64 patients. In univariate analysis, perioperative need of anticoagulation led to a significant increase in urethral erosion (6 vs. 30 %; p = 0.002) and explantation rate (15 vs. 34 %; p = 0.047). Pelvic irradiation increased postoperative infection rates significantly (0 vs. 10 %; p = 0.018). Penoscrotal approach led to significant increase in urethral erosion rate (0 vs. 21 %; p = 0.015). Implantation of a double cuff led to a significant increase in explantation rate (58 vs. 24 %; p = 0.014), revision rate (75 vs. 38 %; p = 0.017), and infection rate (17 vs. 1 %; p = 0.008). When using cuff size of 3.5 cm, revision rate (20 vs. 50 %; p = 0.026) as well as incontinence rates (40 vs. 82 %; p = 0.014) was significantly lower. In multivariate analysis, only perioperative anticoagulation and double-cuff placement were independent predictors of artificial urinary sphincter failure.

Conclusions

Our findings highlight the influence of perioperative anticoagulative therapy. In addition, the current study provides further evidence that double-cuff implantation should be performed only with caution during primary implantation.

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Title: Risk factors for artificial urinary sphincter failure
Authors: Alexander Kretschmer
Alexander Buchner
Markus Grabbert
Christian G. Stief
Micaela Pavlicek
Ricarda M. Bauer
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 4/2016
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1662-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for artificial urinary sphincter failure

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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