OBJECTIVE: To present the outcomes of men undergoing artificial urinary sphincter implantation and determine the impact a past history of radiation therapy has on the outcomes of prosthetic surgery for stress urinary incontinence.
PATIENTS AND METHODS: A cohort of 77 consecutive men undergoing artificial urinary sphincter implantation for stress incontinence after prostate cancer surgery, including 29 who had also been irradiated, were included in a prospective database and followed up for a mean period of 21.2 months. Continence rates, and incidence of complications, revision and cuff erosion were evaluated with results in irradiated men compared to those who had undergone radical prostatectomy alone. The effect of coexisting hypertension, diabetes mellitus and surgical approach on outcomes were also examined.
RESULTS: Overall the rate of social continence (0-1 pad/day) was 87% and similar in irradiated and non-irradiated men (86.2 vs. 87.5% respectively). Likewise, the incidence of infection (3.4 vs. 0%), erosion (3.4 vs. 2.0%) and revision surgery (10.3 vs. 12.5%) were not significantly different. There was a far greater incidence of co-existing urethral stricture disease in irradiated patients (62.1 vs. 10.4%) which often complicated management, however AUS implantation was still feasible in these men and in four such cases a transcorporal cuff placement was utilized. There were poorer outcomes in diabetic patients, and increased reoperation rate in those men who had a transverse scrotal rather than perineal surgical approach although these did not reach statistical significance.
CONCLUSION: Prior irradiation may increase the complexity of treatment due to a greater incidence of coexisting urethral stricture disease, however these patients are still able to achieve a level of social continence similar to non-irradiated men with no discernable increase in complication rates, cuff erosion or the need for revision surgery. Artificial urinary sphincter implantation remains the gold standard for management of moderate-severe stress incontinence in both irradiated and non-irradiated men following prostate cancer treatment.
Written by:
Sathianathen N, Moon D, McGuigan S. Are you the author?
Monash University, Melbourne, Australia.
Reference: BJU Int. 2013 Oct 16. Epub ahead of print.
doi: 10.1111/bju.12518
PubMed Abstract
PMID: 24131859
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