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Difference between Urethral Circumference and Artificial Urinary Sphincter Cuff Size, and its Effect on Postoperative Incontinence

2013; Lippincott Williams & Wilkins; Volume: 191; Issue: 1 Linguagem: Inglês

10.1016/j.juro.2013.06.052

1527-3792

Jennifer Rothschild, Laura Chang Kit, Lara Seltz, Li Wang, Melissa R. Kaufman, Roger R. Dmochowski, Douglas F. Milam,

Prostate Cancer Diagnosis and Treatment

No AccessJournal of UrologyAdult Urology1 Jan 2014Difference between Urethral Circumference and Artificial Urinary Sphincter Cuff Size, and its Effect on Postoperative Incontinence Jennifer Rothschild, Laura Chang Kit, Lara Seltz, Li Wang, Melissa Kaufman, Roger Dmochowski, and Douglas F. Milam Jennifer RothschildJennifer Rothschild Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author , Laura Chang KitLaura Chang Kit Department of Urological Surgery, Albany Medical College, Albany, New York More articles by this author , Lara SeltzLara Seltz Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author , Li WangLi Wang Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author , Melissa KaufmanMelissa Kaufman Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with American Medical Systems, Allergan and Astellas. More articles by this author , Roger DmochowskiRoger Dmochowski Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Allergan and Ferring. More articles by this author , and Douglas F. MilamDouglas F. Milam Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with American Medical Systems. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.06.052AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed whether a difference between intraoperative urethral circumference and artificial urinary sphincter cuff size affects postoperative outcomes. Materials and Methods: We evaluated the medical records of 87 males who underwent implantation of an artificial urinary sphincter between January 2006 and May 2010. A validated questionnaire was completed by 59 patients for long-term followup. The difference between urethral circumference and artificial urinary sphincter cuff size was calculated. Incontinence was recorded as daily pad use. The primary outcome variable was the postoperative decrease in incontinence. Multivariable linear regression was used to model the effect on postoperative incontinence of the difference between urethral circumference and cuff size. Results: Mean long-term followup was 4.2 years. Median preoperative incontinence was 8 pads per day and median abdominal leak point pressure was 50 cm H2O. Median urethral circumference was 38 mm and the median difference between urethral circumference and artificial urinary sphincter cuff size was 2.5 mm. Median postoperative incontinence was 1 pad per day. A 1 mm increase in the difference between urethral circumference and cuff size resulted in a 1.6% increase in incontinence by 4.5 months postoperatively (95% CI –3.1–6.2, p = 0.487). Paradoxically, each 1 mm increase improved postoperative continence at long-term followup by 29% (95% CI –15–56, p = 0.162). Conclusions: At 4.5-month followup there was no statistical difference in pad use or patient satisfaction when the difference between urethral circumference and artificial urinary sphincter cuff size was less than 4 mm vs 4 mm or greater. However, at long-term followup the 4 mm or greater group reported statistically significantly better continence and satisfaction than the less than 4 mm group. This study does not support efforts to improve continence by minimizing cuff size but rather suggests that modestly up-sizing the cuff may produce improved long-term outcomes. References 1 : Surgical treatment of stress incontinence in men. Neurourol Urodyn2010; 29: 179. 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Link, Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byErickson B (2023) Editorial CommentJournal of Urology, VOL. 209, NO. 4, (749-750), Online publication date: 1-Apr-2023.Kurtzman J, Kerr P and Brandes S (2022) Intraoperative Modification of Artificial Urinary Sphincter Cuffs: Achieving Enhanced Cuff FitJournal of Urology, VOL. 208, NO. 3, (511-513), Online publication date: 1-Sep-2022.Bentellis I, El-Akri M, Cornu J, Brierre T, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Bertrand-Leon P, Chevallier D, Bruyere F, Biardeau X, Hermieu J, Lecoanet P, Capon G, Game X, Saussine C, Durand M and Peyronnet B (2021) Prevalence and Risk Factors of Artificial Urinary Sphincter Revision in Nonneurological Male PatientsJournal of Urology, VOL. 206, NO. 5, (1248-1257), Online publication date: 1-Nov-2021.Simhan J, Morey A, Singla N, Tausch T, Scott J, Lemack G and Roehrborn C (2014) 3.5 cm Artificial Urinary Sphincter Cuff Erosion Occurs Predominantly in Irradiated PatientsJournal of Urology, VOL. 193, NO. 2, (593-597), Online publication date: 1-Feb-2015.Simhan J, Morey A, Zhao L, Tausch T, Scott J, Hudak S and Mazzarella B (2014) Decreasing Need for Artificial Urinary Sphincter Revision Surgery by Precise Cuff Sizing in Men with Spongiosal AtrophyJournal of Urology, VOL. 192, NO. 3, (798-803), Online publication date: 1-Sep-2014. Volume 191Issue 1January 2014Page: 138-142Supplementary Materials Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsurethramaleoutcome and process assessment (health care)urinary sphincterartificialurinary incontinenceMetrics Author Information Jennifer Rothschild Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Laura Chang Kit Department of Urological Surgery, Albany Medical College, Albany, New York More articles by this author Lara Seltz Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Li Wang Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Melissa Kaufman Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with American Medical Systems, Allergan and Astellas. More articles by this author Roger Dmochowski Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Allergan and Ferring. More articles by this author Douglas F. Milam Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with American Medical Systems. More articles by this author Expand All Advertisement PDF downloadLoading ...