RESUMO
OBJECTIVE: To identify nonclinical factors affecting postoperative complication rates in patients with neurogenic bladder undergoing benign genitourinary (GU) reconstruction. METHODS: Adult patients with neurogenic bladder undergoing benign GU reconstruction between October 2010 and November 2015 were included. Patients were excluded if a diversion was performed for malignancy, if patients had a history of radiation or if a new bowel segment was not utilized at the time of the operation. Clinical and nonclinical factors were abstracted from the patients' electronic medical records. Health literacy was assessed via the Brief Health Literacy Screen (BHLS), a validated 3-question assessment. Education, marital status, and distance from the medical center were also queried. RESULTS: Forty-nine patients with a neurogenic bladder undergoing complex GU reconstruction met inclusion and exclusion criteria. On average, patients lived 111 miles (standard deviation 89) from the hospital. Overall, mean BHLS score was 10.4 (standard deviation 4.6) with 35% of patients scoring a BHLS of ≤9. Mean years of educational attainment was 9.7, and only 31% of patients completed high school education. In the first month after surgery, 37 patients (76%) experienced a complication, and 22% were readmitted; however, analysis of complication data did not identify an association between any nonclinical variables and complication rates. CONCLUSION: Nonclinical factors including unmarried status, poor health literacy, and marked distance from quaternary care are prevalent in patients with neurogenic bladder undergoing complex GU reconstruction. To mitigate these potential risk factors, the authors recommend acknowledgment of these factors and multidisciplinary support perioperatively to counteract them.
Assuntos
Doenças Urogenitais Femininas/cirurgia , Doenças Urogenitais Masculinas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Feminino , Doenças Urogenitais Femininas/complicações , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Doenças Urogenitais Masculinas/complicações , Estudos Retrospectivos , Fatores Socioeconômicos , Bexiga Urinaria Neurogênica/complicações , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
PURPOSE: American Medical Systems (AMS) CX and LGX penile prostheses use woven Dacron® fabric to produce girth, and length and girth expansion, respectively. Cylinder expansion, while desirable, can result in wear of the material which, over time, may lead to device failure. Therefore, we compared girth and length expanding vs girth expanding cylinder survival rates. In addition, we determined the impact of parylene coating on penile prosthesis revision performed for mechanical reasons. MATERIALS AND METHODS: All patient information forms from AMS 700™ CX and LGX/Ultrex penile prosthesis implantation performed in the United States from January 1997 through August 2008 were retrospectively analyzed (55,013). Device failure was defined as time to first revision. Survival rates of the 2 groups were analyzed and compared, and survival curves were generated. RESULTS: AMS 700 Ultrex/LGX parylene and CX parylene devices demonstrated equivalent estimated survival rates (88.7% vs 89.5%, respectively, log rank p=0.6811). The parylene coated CX and Ultrex/LGX devices outperformed the nonparylene coated devices on survival analysis. CONCLUSIONS: This analysis demonstrated no significant difference in 7-year survival between current generation girth expanding (700 CX) and length and girth expanding (700 LGX/Ultrex) prostheses. This analysis also demonstrated that the parylene coating of the cylinder wall contact surfaces significantly reduced the revision rate of the 700 CX and 700 LGX/Ultrex inflatable penile prostheses.