Artificial urinary sphincter significantly better than fixed sling for moderate postprostatectomy stress urinary incontinence: a propensity score-matched study.

To compare the efficacy of artificial urinary sphincter (AUS) versus retrourethral transobturator sling (RTS) in men with moderate postprostatectomy urinary incontinence (PPI) using the propensity score-matching (PSM) to enhance the validity of the comparison (Canadian Task Force classification II-2).

Consecutive men suffering from moderate (3-5 pad use daily) stress-prevalent PPI were included if implanted with with RTS (TiLOOP® Male) or AUS (AMS800®) since July 2011 to December 2017 and with at least 12 months follow-up. Preoperative assessment included 24h pad usage, International Consultation on Incontinence-Short Form (ICIQ-SF) questionnaire, urethrocystoscopy and urodynamics if indicated. Propensity score matching was based on age, body mass index, Charlson's comorbidity index, pad usage, previous radiotherapy, and urethrotomy. Primary outcome was at least much improved response at 12-months Patient Global Impression of Improvement questionnaire without additional PPI surgery or explantation.

Out of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. Median baseline 24h pad usage was four in both groups (p=0.10), and median follow-up was 51.2 months for AUS and 47.2 months (p=0.5) for RTS patients. In AUS and RTS cohort, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome, 0-1 pad per day rates were 94.3% vs. 68.6% (p=0.012) at 12 months, and 91.4% vs. 68.6% (p=0.034) at last follow-up. Last follow-up median 24h leakage volumes, median ICIQ-SF scores and satisfaction rates were 0 vs. 15 ml (p=0.017), 4 vs. 10 (p=0.001), and 94.3% vs. 68.6% (p=0.012) in the AUS and RTS cohort, respectively. No significant differences were observed in overall rates of complications and reinterventions, although Clavien grade 3 complications (n=3) occurred in the AUS group only. At sensitivity analysis, the study was reasonably robust to hidden bias.

AUS implantation significantly outperforms RTS in patients with moderate PPI for both subjective and objective outcomes.

BJU international. 2020 Aug 03 [Epub ahead of print]

Emilio Sacco, Carlo Gandi, Filippo Marino, Angelo Totaro, Luca Di Gianfrancesco, Giuseppe Palermo, Francesco Pierconti, Marco Racioppi, Pierfrancesco Bassi

"Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy.

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