Patient Risk Factors and Their Association with Patient Reported Urinary Quality of Life following Artificial Urinary Sphincter Placement: A Paired Pre-and Post-operative Analysis.

To evaluate the associations between patient risk factors and incontinence related patient-reported outcome measures (PROMs) pre-and-post artificial urinary sphincter (AUS) implantation. We hypothesize patient risk factors, including prior radiation and diabetes will have a negative association with post AUS PROMs.

A review of prospectively collected pre-and-post-operative Incontinence Symptom Index [ISI] and Incontinence Impact Questionnaire-7 (IIQ-7)s from multiple institutions in the Trauma and Urologic Reconstruction Network of Surgeons was performed. Changes in pre-and-post AUS ISI and IIQ-7 scores were compared for the entire cohort then stratified by patients with prior AUS, obesity, diabetes, prior radiation, and mixed urinary incontinence.

A total of 145 patients, 67.2 (SD 10.9) years had complete pre-and-post AUS questionnaires (median follow up 186 days, IQR 136-362). Post AUS ISI and IIQ-7 scores improved significantly for the group at large. Prior radiation was associated with less improvement in total IIQ-7 scores, -25.5 (31.9) vs. -39 (33.0), p=0.03. Obesity was associated with a greater reduction in incontinence severity -13.6 (SD 9.1) vs. -9.2 (SD 8.9), P<0.01, urge -5.2(SD 4.2) vs. -2.5(SD 4.5), p <0.01, and total ISI score -29.7(SD19.7) vs. -21.2 (SD 19.9), p=0.02. Prior AUS, diabetes, and mixed incontinence were not associated with post AUS PROMs outcome.

Overall, patients reported a significant reduction in incontinence severity, bother, impact, and distress post AUS placement. Prior radiation was associated with less improvement in total IIQ-7 scores. In contrast, obesity demonstrated a greater reduction in ISI severity and urge scores compared to non-obese patients.

Urology. 2022 Jul 26 [Epub ahead of print]

Rachel A Moses, Joshua A Broghammer, Benjamin N Breyer, Bryan B Voelzke, Jill C Buckley, Brad A Erickson, Sean Elliot, Alex J Vanni, Niveditta Ramkumar, Jeremy B Myers

Section of Urology, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Electronic address: ., Department of Urology, University of Kansas, Kansas City, KS, USA. Electronic address: ., Department of Urology, University of California San Francisco, San Francisco, CA, USA. Electronic address: ., Spokane Urology, Spokane, WA, USA. Electronic address: ., Department of Urology, University of California San Diego, San Diego, CA, USA. Electronic address: ., Department of Urology, University of Iowa, Iowa City, IA, USA. Electronic address: ., Department of Urology, University of Minnesota, Minneapolis, MN, USA. Electronic address: ., Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA. Electronic address: ., Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Electronic address: ., Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA. Electronic address: .