Is there a case for centralisation of artificial urinary sphincters (AUS) and slings for post-prostatectomy urinary incontinence?
BAUS ePoster online library. Dosanjh A. Jun 24, 2019; 259545; P5-15 Disclosure(s): I declare no conflict of interest
Dr. Amandeep Dosanjh
Dr. Amandeep Dosanjh
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Abstract
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INTRODUCTION

Stress urinary incontinence (SUI) to some degree following radical prostatectomy (RP) is almost inevitable; if conservative measures fail surgical management with an AUS or a trans-obturator sling is indicated. This study aims to consider the provision of post-RP continence surgery in England.

METHODS

This is a non-comparative retrospective study of AUS and slings using HES data following RP, between January 2010 and March 2018.

RESULTS

1414 patients received index AUS, 10.3% of which had prior radiotherapy. The sling cohort contained 816 patients; 6.7% received prior radiotherapy. 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; 7.7% had a second AUS. Prior sling conferred no increased risk of redo/removal. Patients in high volume centres were less likely to require redo/removal (HR0.24 p =0.020 95%CI 0.07-0.80). 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 (HR 2.19 p=0.029 95%CI 1.08-4.42). Emergency readmissions within 30 days of index operation were 4.4% and 8.1% 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. 18.4% and 33.3% of centres performed < 6 procedures in the study period, for AUS and sling respectively.

CONCLUSION

Centres performing more procedures have fewer re-operations and re-admissions than low volume centres. Centralisation may improve surgical outcomes.
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