Difference between urethral circumference and artificial urinary sphincter cuff size, and its effect on postoperative incontinence

Jennifer Rothschild, Laura Chang Kit, Lara Seltz, Li Wang, Melissa Kaufman, Roger Dmochowski, Douglas F. Milam

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose: We assessed whether a difference between intraoperative urethral circumference and artificial urinary sphincter cuff size affects postoperative outcomes. Materials and Methods: We evaluated the medical records of 87 males who underwent implantation of an artificial urinary sphincter between January 2006 and May 2010. A validated questionnaire was completed by 59 patients for long-term followup. The difference between urethral circumference and artificial urinary sphincter cuff size was calculated. Incontinence was recorded as daily pad use. The primary outcome variable was the postoperative decrease in incontinence. Multivariable linear regression was used to model the effect on postoperative incontinence of the difference between urethral circumference and cuff size. Results: Mean long-term followup was 4.2 years. Median preoperative incontinence was 8 pads per day and median abdominal leak point pressure was 50 cm H2O. Median urethral circumference was 38 mm and the median difference between urethral circumference and artificial urinary sphincter cuff size was 2.5 mm. Median postoperative incontinence was 1 pad per day. A 1 mm increase in the difference between urethral circumference and cuff size resulted in a 1.6% increase in incontinence by 4.5 months postoperatively (95% CI -3.1-6.2, p = 0.487). Paradoxically, each 1 mm increase improved postoperative continence at long-term followup by 29% (95% CI -15-56, p = 0.162). Conclusions: At 4.5-month followup there was no statistical difference in pad use or patient satisfaction when the difference between urethral circumference and artificial urinary sphincter cuff size was less than 4 mm vs 4 mm or greater. However, at long-term followup the 4 mm or greater group reported statistically significantly better continence and satisfaction than the less than 4 mm group. This study does not support efforts to improve continence by minimizing cuff size but rather suggests that modestly up-sizing the cuff may produce improved long-term outcomes.

Original languageEnglish (US)
Pages (from-to)138-142
Number of pages5
JournalJournal of Urology
Volume191
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Fingerprint

Artificial Urinary Sphincter
Patient Satisfaction
Medical Records
Linear Models
Pressure

Keywords

  • artificial
  • male
  • outcome and process assessment (health care)
  • urethra
  • urinary incontinence
  • urinary sphincter

ASJC Scopus subject areas

  • Urology

Cite this

Difference between urethral circumference and artificial urinary sphincter cuff size, and its effect on postoperative incontinence. / Rothschild, Jennifer; Chang Kit, Laura; Seltz, Lara; Wang, Li; Kaufman, Melissa; Dmochowski, Roger; Milam, Douglas F.

In: Journal of Urology, Vol. 191, No. 1, 01.2014, p. 138-142.

Research output: Contribution to journalArticle

Rothschild, Jennifer ; Chang Kit, Laura ; Seltz, Lara ; Wang, Li ; Kaufman, Melissa ; Dmochowski, Roger ; Milam, Douglas F. / Difference between urethral circumference and artificial urinary sphincter cuff size, and its effect on postoperative incontinence. In: Journal of Urology. 2014 ; Vol. 191, No. 1. pp. 138-142.
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abstract = "Purpose: We assessed whether a difference between intraoperative urethral circumference and artificial urinary sphincter cuff size affects postoperative outcomes. Materials and Methods: We evaluated the medical records of 87 males who underwent implantation of an artificial urinary sphincter between January 2006 and May 2010. A validated questionnaire was completed by 59 patients for long-term followup. The difference between urethral circumference and artificial urinary sphincter cuff size was calculated. Incontinence was recorded as daily pad use. The primary outcome variable was the postoperative decrease in incontinence. Multivariable linear regression was used to model the effect on postoperative incontinence of the difference between urethral circumference and cuff size. Results: Mean long-term followup was 4.2 years. Median preoperative incontinence was 8 pads per day and median abdominal leak point pressure was 50 cm H2O. Median urethral circumference was 38 mm and the median difference between urethral circumference and artificial urinary sphincter cuff size was 2.5 mm. Median postoperative incontinence was 1 pad per day. A 1 mm increase in the difference between urethral circumference and cuff size resulted in a 1.6{\%} increase in incontinence by 4.5 months postoperatively (95{\%} CI -3.1-6.2, p = 0.487). Paradoxically, each 1 mm increase improved postoperative continence at long-term followup by 29{\%} (95{\%} CI -15-56, p = 0.162). Conclusions: At 4.5-month followup there was no statistical difference in pad use or patient satisfaction when the difference between urethral circumference and artificial urinary sphincter cuff size was less than 4 mm vs 4 mm or greater. However, at long-term followup the 4 mm or greater group reported statistically significantly better continence and satisfaction than the less than 4 mm group. This study does not support efforts to improve continence by minimizing cuff size but rather suggests that modestly up-sizing the cuff may produce improved long-term outcomes.",
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