Hypothesis / aims of study
Very few studies report on patient experience through their pathway following incontinence surgery. The aim of this study was to investigate the outcomes of the male sling (MS; AdVance XP™) and the Artificial Urinary Sphincter (AUS; AMS 800™) in the treatment of bothersome post-prostatectomy stress urinary incontinence (PPSUI). In addition, patient experience and satisfaction following surgery was evaluated using a validated patient reported experience measure (PREM) and patient reported outcome measures (PROMs).
Study design, materials and methods
In this single centre prospective study, we assessed outcomes in 91 males who had received treatment with a MS or AUS between 2013 and 2017. Patients were asked to complete the ICIQ:UI-SF, MLUTS, and LUTSQoL pre-operatively, and then at each follow-up visit. Patients with a minimum follow up of 1 year were also contacted and completed 2 questionnaires; the client satisfaction questionnaire (CSQ-8), and treatment benefit scale (TBS). In general patients with mild incontinence (24 hour pad weight < 100g) were treated with a MS and those with severe incontinence (24 hour pad weight > 500g) or whom had a history of radiotherapy were treated with an AUS. Those with moderate incontinence without radiotherapy (24 hour pad weight 100-500g) were offered a choice of either MS or AUS.
PPSUI was as a result of radical prostatectomy in 94% of cases. 38 patients received a MS, whilst 48 received an AUS. Five patients (5.3%) were excluded due to incomplete questionnaires. The mean follow-up was 32 months (range 12 to 60). In the MS group, daily pad use fell from 2.84 to 0.52 at 1-year (p < 0.001). ICIQ-UI SF scores improved from 16.47 to 5.14 (P < 0.001), ICIQ-MLUTS from 19.23 to 12.33 and ICIQ-LUTSQoL from 45.00 to 30.47 at 1-year follow up. In the AUS group, there were significant reductions in the number of pads used per day from an average of 4.00 pre-operatively to 0.52 at 1-year. (p < 0.000). ICIQ-UI SF scores fell from 18.35 to 5.62, ICIQ-MLUTS scores fell from 27.58 to 12.63 and ICIQ-LUTSQoL scores from 54.50 to 26.00. Seventy-five patients had at least one year follow up. The mean CSQ-8 score was 29.8 (S.D. 3.60) out of 32. The mean TBS score was 1.54 (S.D. 0.84) out of 4. 65 patients (85.5%) gave a score of at least 1 or 2 showing that the treatment improved or greatly improved their condition. High CSQ-8 and low TBS scores showed a statistically significant correlation of -0.823 (P=0.01). Complication rates were higher in the AUS group 24.1% vs 15.4%. AUS revision or removal surgery rate over the study period duration was 10%. In the MS group 11% have undergone or are planned AUS surgery.
Interpretation of results
Our study suggests this protocolised approach to PPSUI is effective. ICIQ scores decrease which suggest an improvement in incontinence, symptoms and quality of life. High CSQ-8 scores indicate excellent satisfaction with the service. Low TBS scores indicate a high level of patient satisfaction with treatment and this appears to be correlated to those who report receiving a good service. Complications are in keeping with the published literature.