To evaluate the impact of diabetes and obesity on artificial urinary sphincter (AUS) outcomes.
From 1987-2011, men with available diabetes and body mass index (BMI) information (568 of 954) undergoing primary AUS placement at our institution were evaluated. The incidence of all-cause re-intervention, mechanical failure, atrophy, and erosion/infection were assessed using the Kaplan-Meier method. Multivariable analyses evaluated the association between clinical characteristics and AUS outcomes.
In total, 90 (16%) men had diabetes. Median follow-up among alive men without AUS event was 5.9 years. Diabetics had a greater 5-yr incidence of erosion/infection (13% vs 8%; p=0.025). On multivariable analysis, diabetes was independently associated with an increased risk of erosion/infection (HR=2.26; p=0.02); whereas, greater BMI was associated with a reduced risk of erosion/infection (obese: HR=0.39; p=0.02; overweight: HR=0.57; p=0.07). Accordingly, in diabetics, greater average postoperative glucose level (176mg/dL vs 153; p=0.04) and use of non-antibiotic coated devices (13 of 62 vs 1 of 28; p=0.035) was associated with a greater incidence of erosion/infection. There was no difference in social continence (≤1 pad/day) (45% vs 57%; p=0.29), or high-level satisfaction (95% vs 90%; p=0.43) among diabetics vs non-diabetics. However, with greater BMI (<25, 25 to <30, and ≥30), there was a decrease in ≤1 pad/day usage (62% vs 61% vs 49%; p=0.02).
We found that the presence of diabetes was independently associated with a 2.3-fold increased risk of AUS erosion/infection. These findings warrant the consideration of additional periprocedural measures to reduce the risk of this devastating complication.
Urology. 2016 Jun 29 [Epub ahead of print]
Boyd R Viers, Brian J Linder, Marcelino E Rivera, Jack R Andrews, Laureano J Rangel, Matthew J Ziegelmann, Daniel S Elliott
Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota., Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: .