RESUMEN
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.
RESUMEN
The main components of working memory (WM; Baddeley & Hitch, 1974), central executive, phonological loop and visuospatial sketchpad, are related to mathematics skills (Friso-van den Bos, Van der Ven, Kroesbergen, & Van Luit, 2013). Different studies have shown that WM training can increase WM capacity (Randall & Tyldesley, 2016). In that context, this research seeks to verify the effects of WM training on the components of WM as well as on performance in arithmetic and in problem solving among students in the first grades of primary school (6 to 8 years of age). The project also seeks to verify whether improvements are maintained over a six-month period and whether the training has a differential effect in mathematics depending on initial WM capacities. The results of this randomized and controlled study indicate that only central executive capacities are improved by WM training. Gains in verbal modality tend to be maintained over six months while visuo-spatial improvement does not. There was no observable effect on mathematic skills. However, WM training has a differential effect on problem solving, since children who had low initial WM performance did improve their problem solving performance. In conclusion, the effects of WM training are specific, generally to the central executive, and differentially to problem solving skills among those students with lower WM capacities. (PsycINFO Database Record
