Objective
To further understand the implications of adjuvant radiation on artificial urinary
sphincter (AUS) durability in postprostatectomy patients.
Methods
One hundred fifty-eight postprostatectomy patients, identified by retrospective chart
review, underwent AUS placement by 1 surgeon from 2008 to 2016. Time-to-event analysis
measured the effect of adjuvant radiation on all-cause failure, and competing-risks
regression stratified failure by cause (infection or erosion, urethral atrophy, mechanical
failure).
Results
Adjuvant radiation independently predicted all-cause failure over time (hazard ratio = 4.32,
P <.01) When stratifying failure by cause, we find that adjuvant radiation patients
have increased risk of infection or erosion complications (hazard ratio = 4.48, P = .03). However, there was no statistical increase in urethral atrophy or mechanical
failure. Lastly, among patients who have urethral comorbidities (bladder neck contracture,
prior urethral sling, or urethral stricture), those with radiation history have particularly
poor outcomes (22.4% revision-free survival at 3 years).
Conclusion
In our series of postprostatectomy patients, adjuvant radiation portends worse AUS
device survival over time. Furthermore, this decrease in revision-free survival appears
to be concentrated in an increase in infection or erosion complications. Patients
with prior urethral injury or manipulation who have also undergone adjuvant radiation
should be carefully selected when receiving an AUS as this subset of patients experiences
low device survival.
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Article info
Publication history
Published online: January 05, 2018
Accepted:
December 21,
2017
Received:
September 22,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
