(499) Exploring Risk Factors for Re-Operation Following Male Artificial Urinary Sphincter and Urethral Sling Implantation in a Multiethnic, Diverse Academic Center
Authors: Cheung T , Labagnara K , Goetz J , Loloi J , Babar M , Bernstein A , Davuluri M , Maria P 
Published: May 2023

Abstract

Introduction
New onset stress urinary incontinence (SUI) is the second most common complication following a prostatectomy, significantly affecting an estimated 10-20% of patients. Severe cases of SUI are often managed surgically by artificial urinary sphincter (AUS) or urethral sling implantation, depending on patient preference and incontinence severity. However, despite a large portion of these patients requiring surgical revision, there is a lack of information regarding the risk factors associated with reoperation, particularly in diverse populations. Thus, in this study, we analyzed the impact of demographic and intraoperative characteristics on reoperation risk following sling and AUS device implantation.

Objective
To identify risk factors for reoperation following primary AUS and urethral sling implantation. Secondarily, we aim to see if there was a difference in reoperation rates between the two procedures.

Methods
We performed a retrospective review of primary AUS and urethral slings implanted at a single academic center from July 2015 to May 2022. Demographic data, SUI severity (measured in pads per day), intraoperative characteristics, and 30-day safety outcomes were collected. Baseline characteristics were analyzed using a two-sample t-test, chi-square, or Mann-Whitney U test depending on distribution normality. Reoperation risk factors were analyzed utilizing Cox proportional hazard models for univariate and multivariate analysis, and a Kaplan Meier curve was used to depict re-operation time between sling and AUS.

Results
A total of 116 patients were included, 72 (62.1%) of which underwent urethral sling placement and 44 (37.9%) AUS implantation. The reoperation rate was 19.4% for urethral slings and 34.1% for AUS (p=0.077). Baseline characteristics between slings and sphincters differed in mean age (64.0 [7.1] vs 67.2 [7.5], p=0.024), median preoperative pads per day (2 [1-3] vs 3 [2-5], p&lt;0.001), and history of XRT (11.1% vs 29.5%, p=0.012). After controlling for factors significant on univariate analysis (age, cardiovascular disease, and hyperlipidemia), multivariate analysis revealed that higher pads per day (OR=1.71, p=0.027) significantly increased the likelihood of sling reoperation, while age (OR=1.17, p=0.005) significantly increased the likelihood of AUS reoperation. Cardiovascular disease (CVD) (OR=0.10, p=0.003) and former smoking status (OR=0.17, p=0.018) were protective of AUS reoperation. There was no difference between sling and AUS reoperation on a log rank test (p=0.21).

Conclusions
A greater number of preoperative pads per day is associated with increased rates of reoperation following sling implantation, while age, CVD, and former smoking status are associated with AUS reoperation. Further research is warranted to identify patient-specific risk factors, particularly to clarify the effects of CVD and former smoking status on reoperation.

Disclosure
No