Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation
Purpose This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Methods Data from our institutional AUS database sp...
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| Format: | Article |
| Language: | English |
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Korean Continence Society
2023-06-01
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| Series: | International Neurourology Journal |
| Subjects: | |
| Online Access: | http://einj.org/upload/pdf/inj-2346030-015.pdf |
| _version_ | 1797792705894416384 |
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| author | Sylvia Weis Tim A. Ludwig Omar Bahassan Philipp Gild Malte W. Vetterlein Margit Fisch Roland Dahlem Valentin Maurer |
| author_facet | Sylvia Weis Tim A. Ludwig Omar Bahassan Philipp Gild Malte W. Vetterlein Margit Fisch Roland Dahlem Valentin Maurer |
| author_sort | Sylvia Weis |
| collection | DOAJ |
| description | Purpose This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Methods Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Results Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74–81 years; median follow-up, 4.4 years; IQR, 3–6.9 years). Before downsizing, SUI was very severe (ICIQ score 19–21) or severe (ICQ score 13–18) in 80% of patients, moderate (ICIQ score 6–12) in 12%, and slight (ICIQ score 1–5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Conclusions Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks. |
| first_indexed | 2024-03-13T02:37:44Z |
| format | Article |
| id | doaj.art-c2cc2735e435420695859f6a05b0fc2a |
| institution | Directory Open Access Journal |
| issn | 2093-4777 2093-6931 |
| language | English |
| last_indexed | 2024-03-13T02:37:44Z |
| publishDate | 2023-06-01 |
| publisher | Korean Continence Society |
| record_format | Article |
| series | International Neurourology Journal |
| spelling | doaj.art-c2cc2735e435420695859f6a05b0fc2a2023-06-28T23:48:35ZengKorean Continence SocietyInternational Neurourology Journal2093-47772093-69312023-06-0127213914510.5213/inj.2346030.0151062Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter ImplantationSylvia WeisTim A. Ludwig0Omar Bahassan1Philipp Gild2Malte W. Vetterlein3Margit Fisch4Roland Dahlem5Valentin Maurer6 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyPurpose This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Methods Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Results Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74–81 years; median follow-up, 4.4 years; IQR, 3–6.9 years). Before downsizing, SUI was very severe (ICIQ score 19–21) or severe (ICQ score 13–18) in 80% of patients, moderate (ICIQ score 6–12) in 12%, and slight (ICIQ score 1–5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Conclusions Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.http://einj.org/upload/pdf/inj-2346030-015.pdfams 800artificial urinary sphincterreconstructive urologystress urinary incontinencecuff downsizing |
| spellingShingle | Sylvia Weis Tim A. Ludwig Omar Bahassan Philipp Gild Malte W. Vetterlein Margit Fisch Roland Dahlem Valentin Maurer Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation International Neurourology Journal ams 800 artificial urinary sphincter reconstructive urology stress urinary incontinence cuff downsizing |
| title | Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation |
| title_full | Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation |
| title_fullStr | Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation |
| title_full_unstemmed | Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation |
| title_short | Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation |
| title_sort | outcomes and complication rates of cuff downsizing in the treatment of worsening or persistent incontinence after artificial urinary sphincter implantation |
| topic | ams 800 artificial urinary sphincter reconstructive urology stress urinary incontinence cuff downsizing |
| url | http://einj.org/upload/pdf/inj-2346030-015.pdf |
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