To analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort.
Two hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n=127 adjustable male sling [n=95 Argus classic, n=32 Argus T], n=155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P<0.05).
We found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P=0.003). The most frequent intraoperative complication was bladder perforation (n=17). Postoperative infection rates did not vary significantly between the respective devices (P=0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P=0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556; P=0.001).
Complication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival.
International neurourology journal. 2017 Jun 21 [Epub]
Alexander Kretschmer, Tanja Hüsch, Frauke Thomsen, Dominik Kronlachner, Alice Obaje, Ralf Anding, Tobias Pottek, Achim Rose, Roberto Olianas, Alexander Friedl, Wilhelm Hübner, Roland Homberg, Jesco Pfitzenmaier, Fabian Queissert, Carsten M Naumann, Carola Wotzka, Torben Hofmann, Roland Seiler, Axel Haferkamp, Ricarda M Bauer, Debates On Male Incontinence (DOMINO)-Project
Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany., Department of Urology, University Medical Center of Johannes-Gutenberg University, Mainz, Germany., Department of Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany., Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany., Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany., Department of Urology, Asklepios Hospital West Hamburg, Hamburg, Germany., Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany., Department of Urology, Hospital Lueneburg, Lueneburg, Germany., Department of Urology, Hospital Göttlicher Heiland Vienna, Vienna, Austria., Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria., Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany., Department of Urology, Evangelic Hospital Bielefeld, Bielefeld, Germany., Department of Urology, University Hospital Muenster, Muenster, Deutschland., Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany., Department of Urology, Diakonie Hospital Stuttgart, Stuttgart, Germany., Department of Urology, Diakonie Hospital Schwäbisch Hall, Schwäbisch Hall, Germany., Department of Urology, University Hospital Bern, Bern, Switzerland.