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      Risk Factors for Failure of Male Slings and Artificial Urinary Sphincters: Results from a Large Middle European Cohort Study

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          Abstract

          Introduction: We analysed the impact of predefined risk factors: age, diabetes, history of pelvic irradiation, prior surgery for stress urinary incontinence (SUI), prior urethral stricture, additional procedure during SUI surgery, duration of incontinence, ASA-classification and cause for incontinence on failure and complications in male SUI surgery. Materials and Methods: We retrospectively identified 506 patients with an artificial urinary sphincter (AUS) and 513 patients with a male sling (MS) in a multicenter cohort study. Complication rates were correlated to the risk factors in univariate analysis. Subsequently, a multivariate logistic regression adjusted to the risk factors was performed. A p value <0.05 was considered statistically significant. Results: A history of pelvic irradiation was an independent risk factor for explantation in AUS (p < 0.001) and MS (p = 0.018). Moreover, prior urethral stricture (p = 0.036) and higher ASA-classification (p = 0.039) were positively correlated with explantation in univariate analysis for AUS. Urethral erosion was correlated with prior urethral stricture (p < 0.001) and a history of pelvic irradiation (p < 0.001) in AUS. Furthermore, infection was correlated with additional procedures during SUI surgery in univariate analysis (p = 0.037) in MS. Conclusions: We first identified the correlation of higher ASA-classification and explantation in AUS. Nevertheless, only a few novel risk factors had a significant influence on the failure of MS or AUS.

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          Hemoglobin A1c is a Predictor of Healing Rate In Diabetic Wounds

          Lower-extremity wounds are a major complication of diabetes. Hemoglobin A1c (HbA1c) reflects glycemia over 2–3 months and is the standard measure used to monitor glycemia in diabetic patients, but results from studies have not shown a consistent association of HbA1c with wound healing. We hypothesized that elevated HbA1c would be most associated with poor wound healing. To test this hypothesis we conducted a retrospective cohort study of 183 diabetic individuals treated at the Johns Hopkins Wound Center. Our primary outcome was wound-area healing rate (cm2/day). Calibrated tracings of digital images were used to measure wound area. We estimated coefficients for healing rate using a multiple linear regression model controlling for clustering of wounds within individuals and other common clinic variables. The study population was 45% female and 41% black with mean age of 61 years. Mean HbA1c was 8.0% and there were 2.3 wounds per individual (310 wounds total). Of all measures assessed, only HbA1c was significantly associated with wound-area healing rate. Specifically, for each 1.0% point increase in HbA1c, the daily wound-area healing rate decreased by 0.028 cm2/day (95% CI: 0.003, 0.0054, p=0.027). Our results suggest that glycemia, as assessed by HbA1c, may be an important biomarker in predicting wound healing rate in diabetic patients.
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            Long-term Outcomes Following Artificial Urinary Sphincter Placement: An Analysis of 1082 Cases at Mayo Clinic.

            To evaluate long-term device outcomes following primary artificial urinary sphincter (AUS) implantation.
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              Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study.

              To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection.
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                Author and article information

                Journal
                UIN
                Urol Int
                10.1159/issn.0042-1138
                Urologia Internationalis
                Urol Int
                S. Karger AG (Basel, Switzerland karger@ 123456karger.com http://www.karger.com )
                0042-1138
                1423-0399
                03 September 2016
                :
                :
                Affiliations
                aUniversity Medical Center of Johannes Gutenberg University Mainz, Department of Urology and Pediatric Urology, Mainz, bDepartment of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Munich, cDepartment of Urology University Hospital Frankfurt, Frankfurt, dDepartment of Urology, St. Bernward Hospital Hildesheim, Hildesheim, eDepartment of Urology and Paediatric Urology, University Hospital Bonn, Bonn, fDepartment of Urology, Asklepios Hospital West Hamburg, Hamburg, gDepartment of Urology and Paediatric Urology, Helios Hospital Duisburg, Duisburg, hDepartment of Urology, Hospital Lüneburg, Lüneburg, iDepartment of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, jDepartment of Urology, Evangelic Hospital Bielefeld, Bielefeld, kDepartment of Urology and Paediatric Urology, Helios Hospital Schwelm, Schwelm, lDepartment of Urology, University Hospital Muenster, Muenster, mDepartment of Urology and Paediatric Urology, University Hospital Kiel, Kiel, nDepartment of Urology and Paediatric Urology, Catholic Hospital St. Johann Nepomuk, Erfurt, oDepartment of Urology, Diakonie Hospital Stuttgart, Stuttgart, pDepartment of Urology and Paediatric Urology, University Hospital Heidelberg, Heidelberg, qDepartment of Urology, Diakonie Hospital Schwäbisch Hall, Schwäbisch Hall, and rTechnical University Munich, Institute of Medical Statistic and Epidemiology, Munich, Germany; sDepartment of Urology, Göttlicher Heiland Vienna, Vienna, and tDepartment of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria; uVancouver Prostate Centre, University of British Columbia, Vancouver, Canada
                Article
                UIN449232 Urol Int
                10.1159/000449232
                27598774
                1a0f08a1-54ce-4675-935a-806bb7e73a90
                © 2016 S. Karger AG, Basel

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                History
                : 19 May 2016
                : 17 August 2016
                Page count
                Figures: 1, Tables: 5, References: 23, Pages: 8
                Categories
                Original Paper

                Medicine,General social science
                Implant surgery,Risk factor,Artificial urinary sphincter,Male sling,Stress urinary incontinence

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