The Role of Educational Level and Cognitive Status of Patients on Outcomes and Revision Rates of Artificial Urinary Sphincter in Men with Post-Prostatectomy Incontinence: The First Multi-Institutional Study in Turkish Men

Keles A1, Onur R2, Dincer M3, Koca O4, Coskun B5, Karakeci A6, Garayev A7

Research Type

Basic Science / Translational

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 77
Open Discussion ePosters
Scientific Open Discussion ePoster Session 7
Wednesday 29th August 2018
12:05 - 12:10 (ePoster Station 2)
Exhibition Hall
Male Incontinence New Instrumentation Stress Urinary Incontinence Quality of Life (QoL)
1. Istanbul Esenyurt State Hospital,Department of Urology,Istanbul,Turkey, 2. Marmara University School of Medicine,Department of Urology,Istanbul,Turkey, 3. Bagcilar Education and Research Hospital,Department of Urology,Istanbul,Turkey, 4. Haydarpasa Numune Education and Research Hospital,Department of Urology,Istanbul,Turkey, 5. Uludag University School of Medicine,Department of Urology,Bursa,Turkey, 6. Firat University School of Medicine,Department of Urology,Elazig,Turkey, 7. Istanbul Bilim University,Florance Nightingale Hospital,Department of Urology,Istanbul,Turkey

Ahmet Keles




Hypothesis / aims of study
The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for male stress urinary incontinence (SUI). It’s considered as the gold standard especially for treatment of moderate to severe urinary incontinence. Despite its long term use and experience related to the procedure, predictors of failure and/or all factors related to revision has not been fully understood. In the present multi-institutional patient cohort, we aimed to examine the outcomes of AUS implantation as wel as relationship between the education level and cognitive function of patients and the rate of device failure and/or re-operation (revision or replacement) rates in patients with prost prostatectomy incontinence.
Study design, materials and methods
Between 2007 and 2017, the data of a total of 108 patients who received AUS implantation were examined.Surgical outcome in each patient was determined and  failure of treatment, the revisions required, time to revision from the initial implantation were noted. Pre and post-operative incontinence was evaluated by a  validated questionnaire, International Consultation on Incontinence Questionnaire - short form (ICIQ-SF), whereas health related quality of life and subjective satisfaction of the patients was evaluated with the Patient Global Impression of Improvement (PGI-I) questionnaire. We also examined the role of the education level and cognitive function of patients on the development of device failure and/or re-operation (revision or replacement) rates. The education level was determined by assessing the International Standard Classification of Education (ISCED). The scale ranges from 1 (elementary school not nished) to 9 (university level).  Similarly, cognitive function was examined by using the  Mini Mental Status Examination (MMSE).  Failure was defined as start of leakage after a “dry or occasional leakage” period of at least 3 months and/or need for revision. Urinary tract infection, stone formation and difficulty on voiding due to erosion or mechanical failure necessitating replacement and/or exploration of device was also considered failure and revision
The median age of the patients was 68 years (range: 49-84), and the mean follow-up duration was 41.0 ± 37 months (range: 3-133) Table 1 shows additional demographic data, intraoperative variables,and comorbidity information. There was no perioperative severe complication. The ICIQ-SF score improved from 17.5 ± 3.2 to 5 ± 5.21 (P <.001) at the last follow-up. The median outcome on the PGI-I scale was “much better,” and 62 (57.4%) patients subjectively reported improvement. A total of 33 (30.6%) patients failed the procedure and required revision. The reasons for revisions: 7 patients developed infection, mechanical failure was present in 11 and erosion developed in 15 patients.   
The MMSE scores except moderate cognitive impairment did not affect the revision requirement. Similarly, no significant correlation was found between educational levels and revisions except level I educational level. Obesity was also found to be related to revision after AUS placement. Table 2 shows predictor factors for AUS failure/revision.
Interpretation of results
Overall treatment efficacy after AUS implantation revealed satisfactory results for the treatment of PPI. We found lowest patient education level, moderate cognitive impairment and obesity to be related to the increased rate of revisions after AUS placement.
Concluding message
Artificial urinary sphincter is considered the gold standard treatment modality for male stress urinary incontinence. In this study, we reported the role of educational level and MMSE of patients on the outcomes of  the procedure. Overall, AUS implantation seems to be a safe and effective treatment option for  cognitively intact, non-obese and moderate-to-well educated patients. However, additional trials  and larger series with long-term follow-up are needed to determine the predictive factors for success.
Figure 1
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Funding None Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics not Req'd Retrospective datas were used, and all patient well informed. Helsinki Yes Informed Consent Yes