Comparison Study between Artificial Urinary Sphincter and Adjustable Male Sling: A Propensity-Score-Matched Analysis

Paolo Geretto; Enrico Ammirati; Marco Falcone; Alberto Manassero; Marco Agnello; Marcello Della Corte; Paolo Gontero; Alessandro Giammò

doi:10.3390/jcm12175489

Comparison Study between Artificial Urinary Sphincter and Adjustable Male Sling: A Propensity-Score-Matched Analysis

J Clin Med. 2023 Aug 24;12(17):5489. doi: 10.3390/jcm12175489.

Authors

Paolo Geretto¹, Enrico Ammirati¹, Marco Falcone^{1

2}, Alberto Manassero¹, Marco Agnello¹, Marcello Della Corte^{1

3}, Paolo Gontero², Alessandro Giammò¹

Affiliations

¹ Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy.
² Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy.
³ Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy.

Abstract

Aims: This study aimed to compare the outcomes of the AUS and an adjustable male sling (ATOMS^TM).

Methods: It was a retrospective observational cohort study with two arms. Propensity score matching (PSM) was performed in order to limit selection bias and, consequently, a comparison between groups in terms of functional outcomes (24 h pad test and perception of improvement questionnaires), complications (overall complications, high-grade complications, reinterventions and explantations) and device survival was performed.

Results: 49 patients in both arms were included. The baseline characteristics were similar between the groups. The mean follow up was 43 ± 35 months. Dryness was achieved in 22 patients (44.9%) in the AUS group and 11 (22.5%) in the sling group (p = 0.03). A total of 40 patients declared themselves well improved in the sling group (81%), while 35 (71%) declared the same in the AUS group (p = 0.78). The AUS was associated with more high-grade complications, reinterventions and explantations than the ATOMS^TM. Survival at 60 months was 82 ± 9% in the sling group and 67 ± 7% in the AUS group (p = 0.03).

Conclusions: While the AUS may be characterized by a higher dry rate, it has an increased risk of high-grade complications and reinterventions. It is proposed that the ATOMS prosthesis can be successfully used for patients who require a less invasive procedure that maintains good functional outcomes.

Keywords: artificial urinary sphincter; male sling; male urinary incontinence; urinary incontinence.

Grants and funding

The authors received funding from A.M.I.—Agency for Medical Innovations—exclusively for covering the article processing fees.