Scholars@Duke publication: The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure.

The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure.

Publication , Journal Article

Ajay, D; Zhang, H; Gupta, S; Selph, JP; Belsante, MJ; Lentz, AC; Webster, GD; Peterson, AC

Published in: J Urol

October 2015

PURPOSE: We compared continence outcomes in patients with post-prostatectomy stress urinary incontinence treated with a salvage artificial urinary sphincter vs a secondary transobturator sling. MATERIALS AND METHODS: We retrospectively reviewed the records of patients undergoing salvage procedures after sling failure from 2006 to 2012. Postoperative success was defined as the use of 0 or 1 pad, a negative stress test and pad weight less than 8 gm per day. We performed the Wilcoxon test and used a Cox regression model and Kaplan-Meier survival analysis. RESULTS: A total of 61 men presenting with sling failure were included in study, of whom 32 went directly to an artificial urinary sphincter and 29 received a secondary sling. Of the artificial urinary sphincter cohort 47% underwent prior external beam radiation therapy vs 17% of the secondary sling cohort (p = 0.01). Average preoperative 24 hour pad weight and pad number were higher in the artificial urinary sphincter cohort. Median followup in artificial urinary sphincter and secondary sling cases was 4.5 (IQR 4-12) and 4 months (IQR 1-5), respectively. Overall treatment failure was seen in 55% of patients (16 of 29) with a secondary sling vs 6% (2 of 32) with an artificial urinary sphincter (unadjusted HR 7, 95% CI 2-32 and adjusted HR 6, 95% CI 1-31). CONCLUSION: In this cohort of patients with post-prostatectomy stress urinary incontinence and a failed primary sling those who underwent a secondary sling procedure were up to 6 times more likely to have persistent incontinence vs those who underwent artificial urinary sphincter placement. These data are useful for counseling patients and planning surgery. We currently recommend placement of an artificial urinary sphincter for patients in whom an initial sling has failed.

Duke Scholars

Author Aaron Claude Lentz Urology

Author George David Webster Urology

Author Andrew Charles Peterson Urology

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Published In

J Urol

DOI

10.1016/j.juro.2015.04.106

EISSN

1527-3792

Publication Date

October 2015

Volume

194

Issue

Start / End Page

1038 / 1042

Location

United States

Related Subject Headings

Urology & Nephrology
Urologic Surgical Procedures, Male
Urinary Sphincter, Artificial
Urinary Incontinence, Stress
Suburethral Slings
Retrospective Studies
Prosthesis Failure
Middle Aged
Male
Humans

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Chicago

ICMJE

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Ajay, D., Zhang, H., Gupta, S., Selph, J. P., Belsante, M. J., Lentz, A. C., … Peterson, A. C. (2015). The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure. J Urol, 194(4), 1038–1042. https://doi.org/10.1016/j.juro.2015.04.106

Ajay, Divya, Haijing Zhang, Shubham Gupta, John P. Selph, Michael J. Belsante, Aaron C. Lentz, George D. Webster, and Andrew C. Peterson. “The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure.” J Urol 194, no. 4 (October 2015): 1038–42. https://doi.org/10.1016/j.juro.2015.04.106.

Ajay D, Zhang H, Gupta S, Selph JP, Belsante MJ, Lentz AC, et al. The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure. J Urol. 2015 Oct;194(4):1038–42.

Ajay, Divya, et al. “The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure.” J Urol, vol. 194, no. 4, Oct. 2015, pp. 1038–42. Pubmed, doi:10.1016/j.juro.2015.04.106.

Ajay D, Zhang H, Gupta S, Selph JP, Belsante MJ, Lentz AC, Webster GD, Peterson AC. The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure. J Urol. 2015 Oct;194(4):1038–1042.