Prevalence of Cognitive Impairment and Sphincter Misuse Among Men With Artificial Urinary Sphincters.

OBJECTIVES: To define the prevalence of cognitive impairment and sphincter misuse among men who had undergone AUS placement. METHODS: Men who had previously undergone AUS placement from 2004 to 2019 were assessed through comprehensive telephone surveys. The primary survey outcome was cognitive function, assessed via validated Telephone Mini-Mental State Examination. Secondary survey outcomes included rate of AUS misuse, surgical outcomes, and overall device satisfaction. Statistical analysis was performed to assess for differences between patients with and without cognitive impairment. RESULTS: A total of 74 patients participated, with a mean age and follow-up of 75 and 7.8 years, respectively. Telephone Mini-Mental State Examination assessment revealed cognitive impairment in 18 (24%) patients, 13 (18%) with mild-moderate and 5 (7%) with severe impairment. Overall, 23 (31%) and 11 (15%) patients reported inconsistent use (not cycling AUS with every void) and device neglect, respectively. Patients with impaired cognition were more likely to report difficulty with AUS use compared to those with normal cognition (39% vs 9%, P= .01). There was no difference seen in rates of revision, rates of retention, or urinary tract infections between cognitive groups. CONCLUSIONS: Our study revealed significant rates of cognitive impairment and sphincter misuse among men with AUS. These data suggest a role for long-term follow-up and monitoring for cognitive changes. Prospective study of cognitive decline and surgical outcomes in patients undergoing AUS is warranted.

Study of generic quality of life in patients operated on for post-prostatectomy incontinence.

BACKGROUND: The relationship between urological and psychosocial variables, and generic quality of life in patients operated on for post-prostatectomy incontinence has hardly been studied, and our aim was to investigate this relationship. METHODS: Patients who had an artificial urinary sphincter AMS800 (n = 100) implanted between January 2002 and June 2010 were invited to complete a mailed questionnaire covering demographic data including work ability, urinary and sexual function, anxiety/depression, and generic quality of life. Poor quality of life was defined as a score <40 on either the physical or the mental Short Form 12 summary scales. RESULTS: Of 85 compliant patients, 30 (35%) reported poor generic quality of life and 55 (65%) reported better quality of life at a median follow-up time of 26 months (range 6-104 months). The poor quality of life group showed significantly more overall urinary and sexual problems, and more men had undergone surgical revisions compared with the better quality of life group. Levels of anxiety and depression were significantly higher, and work ability was lower in the poor quality of life group. In multivariate logistic regression models, increased level of depression and impaired work ability, inability to reach orgasm, and not recommending the operation remained significantly associated with poor quality of life. CONCLUSION: Poor generic quality of life after surgery for post-prostatectomy incontinence is more strongly associated with reduced work ability and depression rather than urinary and sexual problems.

Artificial urinary sphincter, Part I: Overview.

Urinary incontinence has a tremendous impact on an individual's quality of life and self-esteem. A number of patients will fail both conservative medical as well as conservative surgical treatments in their pursuit to regain urinary control. The surgical implantation of an artificial urinary sphincter (AUS) is a definitive surgical option to reestablish continence. However, there are many challenges that may arise as a patient progresses through the rigorous preparation, surgical procedure, and recovery process. Understanding the history, various indications, and risks of AUS surgery will aid in counseling patients considering AUS.

Artificial urinary sphincter, Part II: Patient teaching and perioperative care.

As discussed in Part I, effective management of urinary incontinence is a tremendous quality of life intervention. The surgical implantation of an artificial urinary sphincter (AUS) provides a definitive, although invasive, surgical option to re-establish continence. Understanding the intraoperative surgical procedure, postoperative care, and teaching will aid in preparing patients undergoing AUS implantation for successful outcomes.

Artificial urinary sphincter placement in men after cystectomy with orthotopic ileal neobladder: continence, complications, and quality of life.

OBJECTIVES: To review our experience regarding the overall efficacy and safety of an artificial urinary sphincter (AUS) in men with stress urinary incontinence (SUI) after cystoprostatectomy with an orthotopic ileal neobladder. METHODS: We performed a retrospective review of 5 men who underwent placement of an AUS (AMS 800) for severe SUI after radical cystectomy with an orthotopic ileal neobladder. Incontinence symptoms and quality of life were quantified using two validated continence questionnaires (Urogenital Distress Inventory Short Form and Incontinence Impact Questionnaire Short Form) and a brief addendum questionnaire. The degree of continence, perioperative and postoperative complications and infections, symptom distress, quality of life, and patient satisfaction were compared before and after AUS placement. RESULTS: Complete (0 pads per day) or social (1 pad or less per day) continence was reported in 5 of 5 patients after AUS placement. The average pad usage significantly decreased from 6.2 to 0.6 per day (P <0.001). No significant perioperative or postoperative complications or infections were noted. Symptom distress, quality of life, and patient satisfaction were significantly improved after AUS placement (P < 0.01, < 0.0001, and < 0.001, respectively). CONCLUSIONS: With short-term follow-up and a limited number of patients, the placement of an AUS for treatment of SUI after bladder substitution is well tolerated and reliable and has a positive impact on patients' quality of life.

Effect of a urinary control insert on quality of life in incontinent women.

The aim of the study was to evaluate the efficacy, safety and effect on quality of life of the Reliance urinary control insert (Uromed Corp., Needham, MA) in women with genuine stress incontinence. Efficacy was evaluated at baseline and at the end of the 12-month study period by standardized pad-weight studies and by rating scales measuring acceptability, incontinence symptom improvement, ease of learning, comfort and time to habituation, recorded in diaries at monthly intervals in 63 women. The SF-36 Health Survey questionnaire was used to assess quality of life status at baseline without the device and after 12 months of device use. A significant decrease in urine loss at 12 months compared with baseline was shown by standardized pad-weight studies, with and without the device in situ. Urine loss was reduced by more than 80% in 91% of the 63 patients, and 79% were completely dry. Patient diaries showed significant improvement in control of leakage, comfort, and ease of device use during the study period. Short-term-36 Health Status data also indicated significant improvement in the physical functioning score at 12 months. Urinary tract infection and hematuria were the most common adverse effects. The Reliance urinary control insert is an efficacious and safe means of controlling genuine stress incontinence in women. The device was perceived as easy to use and comfortable for these 63 women, and resulted in improved quality of life.

[Current therapy standards in treatment of genuine stress incontinence in the woman with urethral mini-devices]. / Aktueller Therapiestandard in der Behandlung der genuinen Stressinkontinenz der Frau mittels Harnröhren-Mini-Devices.

Conservative treatment of genuine stress urinary incontinence in females gained more and more interest. The use of mini-devices is one of the newly developed therapeutical options however, its clinical relevance and longterm-results are still under debate. This review article gives a critical evaluation of the available urethral plugs and regulators and new developments as well according to the long-term-follow-up studies in the literature and own experience with those devices. The continence rates that can be obtained with the different plugs or regulators are dependent upon the degree of stress incontinence, ability to insert the plug and compliance of the patient. Reported longterm results vary between 48% and 100%. The most frequent side effects are urinary infection, haematuria and/or handling problems with the devices. According to the published material it is impossible to give therapeutical standards for treatment of female stress urinary incontinence with urethral mini-devices. Although proper Patient selection might give excellent longterm-results in patient continence rates.

Mitrofanoff stoma--an iceberg of problems?

The advent of a self-catheterisable continent abdominal wall urinary stoma has provided an enormous improvement in the quality of life for many patients. Successful results of surgery have been presented from many centres. However, these reports concentrate on the technical aspect of patient care. In this paper we review the work of the outreach nursing sister in supporting thirty patients operated upon during a four-year period, and their families.