To further understand the implications of adjuvant radiation on artificial urinary sphincter durability (AUS) in post-prostatectomy patients.
158 post-prostatectomy patients, identified by retrospective chart review, underwent AUS placement by one surgeon from 2008 - 2016. Time-to-event analysis measured the effect of adjuvant radiation on all-cause failure and competing risks regression stratified failure by cause (infection/erosion, urethral atrophy, mechanical failure).
Adjuvant radiation independently predicted all-cause failure over time (HR = 4.32, p<0.01) When stratifying failure by cause, we find that adjuvant radiation patients have increased risk of infection/erosion complications (HR = 4.48, p=0.03). 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).
In our series of post-prostatectomy 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/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.
Urology. 2018 Jan 05 [Epub ahead of print]
Arnav Srivastava, Gregory A Joice, Hiten D Patel, Madeleine G Manka, Nikolai A Sopko, E James Wright
James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. Electronic address: ., James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. Electronic address: ., James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. Electronic address: ., Department of Urology, Mayo Clinic, Rochester MN, USA. Electronic address: ., James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. Electronic address: ., James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. Electronic address: .