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Prebay ZJ, Fu DH, Chung PH. Androgens and Urethral Health: How Hypogonadism Affects Postoperative Outcomes of Patients Undergoing Artificial Urinary Sphincter or Inflatable Penile Prosthesis Placement. Urology 2024; 184:266-271. [PMID: 37972898 DOI: 10.1016/j.urology.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To determine the role of androgens in penile and urethral health, we sought to understand what impact hypogonadism may have on artificial urinary sphincter (AUS) and inflatable penile prosthesis (IPP) outcomes. We hypothesize that patients with hypogonadism are at increased risk of reinterventions, complications, and infections. METHODS We queried the TriNetX Global Database in March 2023 for patients receiving an AUS or IPP, looking at lifetime reintervention, complication, and infection rates. We conducted multiple comparisons: (1) eugonadal patients against hypogonadal patients, (2) hypogonadal patients on testosterone replacement therapy (TRT) against hypogonadal patients not on TRT, and (3) hypogonadal patients on TRT against eugonadal patients. RESULTS Hypogonadal patients undergoing AUS had more complications (33.5% vs 28.3%), higher reintervention rates (27.7% vs 24.3%) and higher infection rates (7.3% vs 6.8%), albeit none reaching significance. Hypogonadal patients undergoing IPP had significantly higher infection rates (6.3% vs 4.4%, RR 1.5 (1.04, 2.04)) and reintervention rates (14.9% vs 11.9%, RR 1.3 (1.04, 1.61)), but not complication rates (21.9% vs 18.9%). When comparing patients with hypogonadism on TRT vs off TRT, there was not a significant difference in reinterventions, or complications, in AUS and IPP patients, but there were significantly more infections in IPP patients (7.0% vs 3.9%, RR 1.9 (1.002, 3.5)). CONCLUSION Hypogonadal patients have more reinterventions, complications, and infections following urologic implant surgery, to varying levels of significance. TRT may not be completely protective to improve tissue health but with many limitations that should be explored in further research.
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Affiliation(s)
- Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - David H Fu
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Perrin A, Singh J. Re: Camille Girard, Mehdi Al-Akri, Matthieu Durand, et al. Efficacy, Safety, and Reoperation-free Survival of Artificial Urinary Sphincter in Non-neurological Male Patients over 75 Years of Age. Eur Urol Open Sci 2023;53:23-30. EUR UROL SUPPL 2023; 58:8-9. [PMID: 37920241 PMCID: PMC10618415 DOI: 10.1016/j.euros.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Andry Perrin
- Division of Urology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Jas Singh
- Division of Urology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Girard C, El-Akri M, Durand M, Guérin O, Cornu JN, Brierre T, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Leon P, Chevallier D, Bruyere F, Biardeau X, Hermieu JF, Lecoanet P, Capon G, Game X, Saussine C, Rambaud C, Peyronnet B, Bentellis I. Efficacy, Safety, and Reoperation-free Survival of Artificial Urinary Sphincter in Non-neurological Male Patients over 75 Years of Age. EUR UROL SUPPL 2023; 53:23-30. [PMID: 37441348 PMCID: PMC10334236 DOI: 10.1016/j.euros.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 07/15/2023] Open
Abstract
Background Artificial urinary sphincter (AUS) is a gold standard treatment in male stress urinary incontinence but remains poorly used in elderly patients. Objective To assess the efficacy, safety, and reoperation-free survival of AUS implantation in male patients over 75 yr of age. Design setting and participants We retrospectively reviewed the charts of all 1233 non-neurological male AUS implantations between 2005 and 2020 at 13 French centers. We compared 330 patients ≥75 yr old (GROUP75+) with 903 patients <75 yr old (GROUP75-) at the time of AUS implantation. Outcome measurements and statistical analysis Our primary endpoint was social continence at 3 mo defined as the use of one or fewer pad daily. We used Kaplan-Meier analyses to assess reoperation-free survival. We sought factors of erosion using logistic regression. Results and limitations Early postoperative continence was comparable in both groups (74.4% vs 80.1%, p = 0.114). We observed a higher rate of postoperative complications in GROUP75+ (18.8% vs 12.6%, p = 0.014), but the complications were more frequently of low grade in GROUP75+ (p = 0.025). The overall reoperation-free survival was similar (p = 0.076) after a median follow-up of 2 yr. However, patients in GROUP75+ had poorer explantation-free survival (p < 0.0001). A history of radiotherapy was a predictive factor of erosion (odds ratio [OR] = 5.31, p < 0.01), but age was not (OR = 1.08, p = 0.87). Unfortunately, our dataset did not include a systematic geriatric evaluation. Conclusions AUS in elderly patients appears to be an effective option to treat stress urinary incontinence. However, we observed more postoperative complications and explantations, although age was not associated with the onset of erosion. A prospective study is required to determine whether a geriatric evaluation would be an effective strategy to select patients before surgery. Patient summary In this study, we looked at outcomes of artificial urinary sphincter in elderly men in a large population. We found satisfying efficacy but slightly more postoperative complications and device infections.
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Affiliation(s)
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- University Hospital of Toulouse, Toulouse, France
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Campbell JG, Hayden JP, Vanni AJ. Biomarkers in Urethral Stricture Disease and Benign Lower Urinary Tract Disease. Urol Clin North Am 2023; 50:31-38. [DOI: 10.1016/j.ucl.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fendereski K, Ghaed MA, Calvert JK, Hotaling JM. Hypogonadism and urologic surgeries: a narrative review. Transl Androl Urol 2022; 11:1045-1062. [PMID: 35958902 PMCID: PMC9360521 DOI: 10.21037/tau-22-308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Previous studies indicated that the treatment of male hypogonadism can be beneficial for intraoperative and postsurgical outcomes. In this study, we aimed to determine the impact of male hypogonadism on urologic surgeries. We provided an overview of the key studies in the field with the focus on the outcomes of urologic surgeries in hypogonadal men with/without testosterone replacement therapy (TRT). Methods We performed a literature review in PubMed and Google Scholar databases for the most relevant articles pertaining to the outlined topics without placing any limitations on publication years or study designs. We included full-text English articles published in peer reviewed journals between January 1970 and March 2022. Key Content and Findings Androgen deficiency is a common finding after major urologic surgeries. Although guidelines recommend against TRT in men with prostate carcinoma, recent investigations showed no association between TRT and disease progression and recurrence. Indeed, recent evidence suggested that low androgen levels could be related to high grade prostate carcinoma and increased risk of upgrading from low to high grade disease. Investigations on the application of TRT in benign prostatic hyperplasia (BPH) patients also revealed contrasting results. While some studies suggested higher rates of prostate-related events in men who received TRT, others showed that TRT could alleviate urinary symptoms in hypogonadal men with BPH. Decreased testosterone level is commonly seen in bladder cancer patients. The treatment of perioperative androgen deficiency can reduce postoperative morbidities and lower the risk of recurrence in these patients. Low testosterone levels are observed in approximately half of the men who undergo artificial urinary sphincter (AUS) placement and can increase the risk of complications. Conclusions The role of testosterone treatment in patients with urologic diseases such as prostate carcinoma and BPH is controversial. Further investigations are needed to determine the impact of hypogonadism and TRT on the outcomes of urologic surgeries in patients with androgen deficiency.
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Affiliation(s)
- Kiarad Fendereski
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mohammad Ali Ghaed
- Department of Urology, Rasoul Akram Hospital, Iran university of Medical Sciences, Tehran, Iran
| | - Joshua K Calvert
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Diao L, Nealon SW, Carpinito GP, Badkhshan S, Wolfe AR, Dropkin BM, Sanders SC, Hudak SJ, Morey AF. Presenting signs and symptoms of artificial urinary sphincter cuff erosion. Int Braz J Urol 2022; 48:679-685. [PMID: 35503704 PMCID: PMC9306375 DOI: 10.1590/s1677-5538.ibju.2022.0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To characterize the most common presentation and clinical risk factors for artificial urinary sphincter (AUS) cuff erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these patients. Materials and Methods We retrospectively reviewed our tertiary center database to identify men who presented with AUS cuff erosion between 2007 – 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for symptom comparison. Risk factors for cuff erosion – pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) – were recorded for each patient. Presenting signs and symptoms of cuff erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (SI). Results Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) sustained cuff erosion. Most erosion patients (40/61, 66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling. Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with SI or obstructive symptoms presented significantly earlier than those with worsening incontinence (SI 14 ± 18 vs. obstructive symptoms 15 ± 16 vs. incontinence 37 ± 48 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n=61), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 49%, p=0.02). Conclusion AUS cuff erosion most commonly presents as SI symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.
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Affiliation(s)
- Linley Diao
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samantha W Nealon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gianpaolo P Carpinito
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shervin Badkhshan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avery R Wolfe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah C Sanders
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Testosterone Use in the Perioperative Setting. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-021-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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