The role of educational level and cognitive status in men undergoing artificial urinary sphincter implantation reply

Abstract

Many factors have previously been examined to reveal theelements related to the long-term complications and revisions for artificial urinary sphincter (AUS) surgery. In thisstudy, we tried to highlight the role of a different aspectthat affects patients’ outcomes following AUS implantation.As mentioned in the editorial comment, it is a nightmarefor urologists to find a patient coming to emergency roomwith a urethral catheter placed through a closed cuff, or foran otherwise healthy man to, before undergoing an electiveprocedure, forget to inform his healthcare provider(s) thathe has an AUS in place. This can lead to him presentingwith a subsequent urethral erosion of the AUS cuff. Toavoid such painful consequences, we believe that familymembers and/or home care nurses must definitely beinvolved in the process during the postartificial urinarysphincter period, especially for patients who have cognitivedisorder(s).Alternatively, we could design a card to be handed to familymembers or a home care nurse, to indicate that the patient hasan AUS and for them to show when interacting with healthcareorganizations. The fact that the patient has an AUS could alsobe included in healthcare insurance information, so that healthcare provider(s) are notified about the AUS whenever thepatient visits a healthcare organization.We agree with Raup et al who have suggested that cognitivedisorders influence the outcome of AUS implantation.1 Webelieve that patients and their caregivers should be informedbefore the operation about the fact that a cognitive disorder canaffect the ability to manually control the device, and thusimpacts the prognosis. Another consideration that should bekept in mind is that cognitive disorders may develop years afterthe implantation of an AUS. Thus, pre- and postoperativeobjective assessment tools for cognitive function may be beneficial in men planning to undergo AUS implantation. In the context of this framework, we believe that an AUS should not beimplanted in patients with impaired cognitive functions, asdoing so could be more harmful than beneficial to them, notonly in terms of patient satisfaction but also in terms of potentialcomorbidities (removal of the sphincter, need for anesthesia,increased morbidities, etc.). However, it is apparent that largerprospective studies are still required before definitive conclusionscan be drawn or further suggestions made.