OBJECTIVE: To conduct a systematic review and meta-analysis of AUS placement following radical prostatectomy (RP) and radiotherapy (EBRT).
MATERIALS AND METHODS: A systematic database search was conducted using keywords, according to PRISMA guidelines. Published series of AUS insertion were retrieved, according to the inclusion criteria. The Newcastle-Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA® statistical software.
RESULTS: There were 1886 patients available for analysis of surgical revision outcomes, and 949 for persistent urinary incontinence outcomes from 15 and 11 studies respectively. The mean age (SD) was 66.9 ± 1.4 years and the number of patients per study was 126.6 ± 41.7. Average follow up was 36.7 ± 3.9 months (range, 18 - 68). Artificial urinary sphincter revision was higher in RP + EBRT versus RP alone, with a random effects risk ratio of 1.56 (95% Confidence Interval [CI] 1.02 - 2.72; p< 0.050; I2 = 82.0 %) and a risk difference of 16.0 % (95% CI 2.05 - 36.01; p< 0.080). Infection-erosion contributed to the majority of surgical revision risk compared to urethral atrophy (p=0.020). Persistent urinary incontinence after implantation was greater in EBRT patients (p< 0.001).
CONCLUSIONS: Men receiving RP + EBRT appear at increased risk of infection- erosion and urethral atrophy resulting in a greater risk of surgical revision compared to RP alone. Persistent urinary incontinence is more common with RP + EBRT.
Written by:
Bates A, Martin R, Terry T. Are you the author?
Department of Urology, Leicester General Hospital, University Hospitals of Leicester NHS Trust, United Kingdom.
Reference: BJU Int. 2015 Jan 20. Epub ahead of print.
doi: 10.1111/bju.13048
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PubMed Abstract
PMID: 25601072