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UPJ INSIGHT Preoperative Bladder Mechanics Forecast Time to Artificial Urinary Sphincter Revision
By: Kevin Krughoff, MD, Oregon Urology Institute, Springfield; Jordan Foreman, MD, Duke University Medical Center, Durham, North Carolina; Andrew C. Peterson, MD, Duke University Medical Center, Durham, North Carolina | Posted on: 15 Dec 2023
Krughoff K, Foreman J, Peterson AC. Preoperative bladder mechanics forecast time to artificial urinary sphincter revision. Urol Pract. 2023;10(6):640-645.
Study Need and Importance
The artificial urinary sphincter (AUS) lifespan is typically quoted at 5 to 10 years on average. However, the time to AUS removal and replacement is variable without any means of forecasting individualized AUS survival times. There is a need for a study evaluating individualized variables to predict personalized AUS survival times.
What We Found
In an index postprostatectomy AUS-naïve patient we were able to develop a Cox proportional hazard model to accurately predict their chance of survival at 7 years. Bladder mechanics and factors suspected to underlie more frequent device use demonstrated adequate predictive discrimination for long-term AUS survival using single-institution data. Discrimination was assessed using Harrell’s Concordance Index and excluded records served as a pseudo-validation cohort. Harrell’s C-index for the training cohort was 0.82, suggesting good discrimination, and the pseudo-validation cohort was 0.92, suggesting good accuracy amongst an out-of-sample cohort.
Limitations
Urodynamic (UDS) data served as a surrogate for device use, however the accuracy of this is unverifiable as the actual frequency cannot be measured using retrospective data. Missing data was also a limitation as historical UDS data were not recoverable. Many cases were excluded to capture a cohort with true mechanical fatigue and device failure with few complicating factors. The accuracy cannot be determined in the broader landscape.
Interpretation for Patient Care
The combination of UDS and voiding diary data may help augment follow-up planning and individualized counseling (Figure).
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