AUS implantation effective for managing non-neurogenic urinary incontinence in elderly males
A study published in European Urology Open Science entitled "Efficacy, Safety, and Reoperation-free Survival of Artificial Urinary Sphincter in Non-neurological Male Patients over 75 Years of Age" has determined outcomes of artificial urinary sphincter or AUS in elderly men in a large population and according to them, research results depicted satisfying efficacy but slightly more postoperative complications and device infections.
The findings of this study explain the importance of preoperative patient counselling and careful patient selection, which could be improved through a systematic specialized preoperative geriatric evaluation using validated tools.
Explaining the study background, they said that Urinary incontinence (UI) is highly prevalent in the elderly. It is a risk factor for falls, depression, and anxiety. AUS is a gold-standard therapeutic option in the management of male stress urinary incontinence. It is poorly used in elderly patients. Considering this, we assessed the efficacy, safety, and reoperation-free survival of AUS implantation in males of more than 75 yr of age in our study in which We reviewed the charts of all 1233 non-neurological male AUS implantations (2005 – 2020) at 13 French centres. We compared 330 patients ≥75 yr old (GROUP75+) with 903 patients <75 yr old (GROUP75–) at the time of AUS implantation.
Researchers measured social continence at three mo (use of one or fewer pads daily) as the primary endpoint.
The results of the study are summarised below:
- Early postoperative continence was comparable in both groups, 74.4% vs 80.1%.
- There was a higher rate of postoperative complications in GROUP75+ with recorded values as 18.8% vs 12.6%, p = 0.014.
- There were complications more frequently of low grades in GROUP75+.
- There was similar overall reoperation-free survival after a follow-up of 2 yr (median).
- GROUP75+ patients had poorer explantation-free survival.
- Radiotherapy history was a predictive factor of erosion and not age.
They added, “Unfortunately, our dataset did not include a systematic geriatric evaluation.”
They added, “AUS in elderly patients is an effective option for managing stress urinary incontinence. We found more postoperative complications and explanations, but age was not associated with the onset of erosion.”
Further investigations are warranted to determine whether a geriatric evaluation would be an effective strategy for selecting patients before surgery.
They acknowledged the study’s limitations related to bias, retrospective nature, inaccuracy and the lack of data on patient comorbidities.
Further reading:
https://www.sciencedirect.com/science/article/pii/S2666168323001945
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