A national study of artificial urinary sphincter and male sling implantation following radical prostatectomy in England.

Dosanjh, A and Baldwin, S and Mytton, J and King, D and Trudgill, N and Belal, M and Patel, P (2019) A national study of artificial urinary sphincter and male sling implantation following radical prostatectomy in England. BJU international. ISSN 1464-410X.

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Official URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/bj...

Abstract

OBJECTIVES

To consider the provision of post radical prostatectomy (RP) continence surgery in England.

MATERIALS AND METHODS

Patients between 01/01/2010 and 31/3/2018 with an OPCS-4 code for AUS or male sling were searched for within Hospital Episode Statistics (HES). Those without previous prostatectomy were excluded. Multivariable logistic regressions for repeat AUS and sling procedures were built in STATA. Further descriptive analysis of provision of procedures was performed.

RESULTS

1,414 patients received index AUS, 10.3% of which had prior radiotherapy; median follow-up was 3.55 years. The sling cohort contained 816 patients; 6.7% received prior radiotherapy and median follow-up was 3.23 years. Whilst the numbers of AUS implanted has increased each year, male slings peaked in 2014/2015. AUS redo/removal was performed in 11.2% patients. Patients in low volume centres were more likely to require redo/removal (OR 2.23 95%CI 1.02-4.86 p =0.045). 12.0% patients with a sling progressed to AUS and 1.3% had a second sling. Patients with previous radiotherapy were more likely to require a second operation (OR 2.03 95%CI 1.01-4.06 p=0.046). Emergency re-admissions within 30 days of index operation were 3.9% and 3.6% fewer in high volume centres, for AUS and slings respectively. Median time to initial continence surgery from RP was 2.8 years. Increased time from RP conferred no reduced risk of redo surgery for either procedure.

CONCLUSION

There is a volume effect for outcomes of AUS procedures suggesting that they should only be performed in high volume centres. Given the known impact of incontinence on quality of life, patients should be referred sooner for post-prostatectomy continence surgery.

Item Type: Article
Subjects: WJ Urogenital system. Urology
WO Surgery
Divisions: Planned IP Care > Urology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 29 Nov 2019 12:37
Last Modified: 03 Dec 2019 10:30
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2641

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