Predicting success after artificial urinary sphincter: which preoperative factors drive patient satisfaction postoperatively?

Background: To determine which preoperative factors drive patient-reported quality of life (QoL) after artificial urinary sphincter (AUS) implantation.

Methods: Men receiving AUS after prostate cancer treatment were identified from a prospectively collected dataset. Preoperative factors were recorded during the initial incontinence consultation. Patients underwent urodynamic testing (UDS) preoperatively at surgeon discretion. Patients were surveyed by telephone postoperatively and given the EPIC Urinary Domain (EPIC-UD) and Urinary Distress Inventory (UDI-6) questionnaires. Differences in postoperative maximum pads per day (MxPPD) and questionnaire scores were compared across preoperative factors, with P¡Ü0.05 indicating statistical significance.

Results: Telephone survey was completed by 101 of 238 patients (42%). Median age was 69 [63-75] years, BMI was 29 [26-32] kg/m. MxPPD was 5 [3-9] preoperatively and 2 [1-3] postoperatively (r=0.255, P=0.011). Postoperative median EPIC-UD was 82 [67-89] and UDI-6 was 22 [11-36]. Postoperative MxPPD was lower in patients who reported being able to store urine before AUS {2 [1-2] . 2 [1-4], P=0.046}, and lower with urodynamically-proven detrusor overactivity (DO) {1.5 [1-2] with . 2 [1-4] without, P=0.050}. Detrusor pressure at maximum flow was negatively associated with QoL as measured by EPIC-UD score (r=-0.346, P=0.013) and UDI-6 score (r=0.413, P=0.003). Although 41 (41%) patients had a history of radiation, postoperative outcomes did not significantly differ with or without a history of radiation.

Conclusions: Few preoperative factors predict QoL after AUS insertion.