Diabetes increases the risk of some complications after artificial urinary sphincter placement

This study examined the effect of diabetes on outcomes with artificial urinary sphincters (AUS). Researchers reported that diabetes more than doubled the risk of erosion and/or infection within 5 years after AUS placement.

Artificial urinary sphincters (AUS) can help restore continence among men with severe stress urinary incontinence. The procedure involves the implantation of an inflatable cuff around the bladder base. Inflation of the cuff prevents involuntary urine leakage, and deflation allows the passing of urine when desired. AUS is often associated with very good treatment outcomes and high patient satisfaction. However, it has been estimated that between 25 to 43% of men fitted with an AUS will need a repeat surgery within 5 years, often due to infection or device erosion. Identifying risk factors that could impact AUS outcomes is therefore very important. Diabetes and obesity have previously been suggested to increase the risk of infection and erosion. However, more studies are needed.

The aim of this study was to examine the effect of diabetes on AUS outcomes.

The records of 568 men treated with AUS were analyzed. Of these, 16% of men had diabetes before AUS placement. Rates of complications requiring repeat surgery were recorded over a period of 5 years.

55% of diabetic men were classified as obese compared to 31% of non-diabetic men. High blood pressure, heart disease, and a history of radiation therapy were also more common among men with diabetes.

Overall, 174 men needed a repeat surgery after an average of 3.5 years. Of these, 60 men experienced device failure, 52 men experienced erosion/infection, and 49 men showed signs of local tissue wasting away. No significant differences in 5-year repeat surgery rates, device failure, or tissue damage were observed between diabetic and non-diabetic men.

13% of diabetic men experienced erosion/infection within 5 years after AUS placement. This was significantly higher compared to non-diabetic men (8%). Overall, diabetes increased the risk of erosion/infection 2.26-fold. Among diabetics, the rates of erosion or infection were lower if the AUS device was coated in antibiotics. Higher blood sugar levels in the 24 hours after surgery were associated with higher erosion/infection rates.

Men with a healthy weight had higher rates of erosion/infection over a 5-year period compared to overweight and obese men. Overall, obesity significantly decreased the risk of erosion/infection by 61%.

69% of men were available at the last follow-up. No significant differences in continence rates (based on using 1 or no incontinence pads every day) were noted between diabetic (45%) and non-diabetic men (57%). Satisfaction rates were also similar between diabetic (95%) and non-diabetic men (90%). However, less obese men were continent at the final follow-up (49%) compared to men with a healthy weight (62%).

Researchers concluded that diabetes significantly increased the rates of erosion and/or infection within 5 years after AUS placement.

Larger studies are needed to confirm these findings.