MP40-03 PATIENT SELECTION FOR THE TREATMENT OF MODERATE TO SEVERE MALE URINARY STRESS INCONTINENCE IN HIGH-VOLUME SURGICAL CENTERS OF EXCELLENCE

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You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (MP40)1 Apr 2020MP40-03 PATIENT SELECTION FOR THE TREATMENT OF MODERATE TO SEVERE MALE URINARY STRESS INCONTINENCE IN HIGH-VOLUME SURGICAL CENTERS OF EXCELLENCE Markus Grabbert*, Tanja Huesch, Alexander Kretschmer, Ralf Anding, Ruth Kirschner-Hermanns, Christian Gratzke, Wael Khoder, Fabian Queissert, Tobias Pottek, Axel Haferkamp, Ricarda Michaela Bauer, and Wilhelm Huebner Markus Grabbert*Markus Grabbert* More articles by this author , Tanja HueschTanja Huesch More articles by this author , Alexander KretschmerAlexander Kretschmer More articles by this author , Ralf AndingRalf Anding More articles by this author , Ruth Kirschner-HermannsRuth Kirschner-Hermanns More articles by this author , Christian GratzkeChristian Gratzke More articles by this author , Wael KhoderWael Khoder More articles by this author , Fabian QueissertFabian Queissert More articles by this author , Tobias PottekTobias Pottek More articles by this author , Axel HaferkampAxel Haferkamp More articles by this author , Ricarda Michaela BauerRicarda Michaela Bauer More articles by this author , and Wilhelm HuebnerWilhelm Huebner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000889.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adjustable male slings are a minimally invasive treatment option in male patients with stress urinary incontinence with good results but without a high level of evidence regarding the optimal patient selection. The artificial urinary sphincter (AUS) is the standard treatment for patients with moderate to severe stress urinary incontinence (SUI) in male patients. However, patients´ demand of a less invasive alternative is high. Therefore, goal of our study was an analysis of decision making in expert centers based on preoperative findings. METHODS: In total 220 patients (88 AUS; 132 Adj. Sling Systems) were investigated from the DOMINO database that underwent surgery between 2010 and 2012 in five urological departments, that offer adjustable sling systems as well as artificial urinary sphincter systems for patients with moderate to severe urinary incontinence. For statistical analysis, independent non-parametric T-test and Mann-Whitney U-test were used to identify differences between both groups. All statistical analyses were performed with IBM SPSS Statistics 24.0 (IBM Co., Armonk, NY, USA). A p- value </= 0.05 was considered statistically significant. RESULTS: Patients selected for an adjustable male sling were less likely to have a neurological disease (5.3% vs. 9.1%, p=0.030), a history of urethral stricture (22.7% vs. 50.0%, p=0.001), prior incontinence surgery (24.4% vs. 45.5%, p=0.01) or prior radiation therapy (26.5% vs. 40.1%, p=0.001) compared to patients that were selected for an AUS. The severity of incontinence was higher in patients selected for an AUS implantation with a mean pad usage per day of 7.60 vs. 5.80 (p<0.001) and a greater urine loss in 24h Pad Test (734g vs. 470g, p=0.049). Mean pad usage at maximum follow-up during daytime was comparable in patients with an AUS or an adjustable sling with a mean of 1.77 pads (0-7; SD 1.96) and 1.95 pads (0-7; SD 1.88) respectively (p=0.106). In subgroup analysis of irradiated patients, the mean pad usage was significantly lower in patients with an AUS (mean pad usage daytime: 2.73; SD 1.79 vs. 1.46; SD 1.39; p=0.042). CONCLUSIONS: In centers offering both adjustable sling and AUS implantations the decision making between the two methods is mainly based upon presence of radiation therapy and previous failed incontinence surgery. The AUS is generally chosen for more complex cases, however, inducing a threefold higher explantation rate. Despite the more complex patient cohort selected for an AUS implantation with a higher severity of urinary incontinence postoperative results seem to be acceptable and comparable for both solutions indicating a proper preoperative patient assessment and selection in centers of expertise. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e586-e586 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Markus Grabbert* More articles by this author Tanja Huesch More articles by this author Alexander Kretschmer More articles by this author Ralf Anding More articles by this author Ruth Kirschner-Hermanns More articles by this author Christian Gratzke More articles by this author Wael Khoder More articles by this author Fabian Queissert More articles by this author Tobias Pottek More articles by this author Axel Haferkamp More articles by this author Ricarda Michaela Bauer More articles by this author Wilhelm Huebner More articles by this author Expand All Advertisement PDF downloadLoading ...

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