Radiation history affects continence outcomes after advance transobturator sling placement in patients with post-prostatectomy incontinence

Urology. 2013 Sep;82(3):713-7. doi: 10.1016/j.urology.2013.03.075. Epub 2013 Jul 4.

Abstract

Objective: To evaluate the effects of preoperative external radiation therapy (XRT) on a cohort of patients who underwent AdVance transobturator urethral sling (ATUS) placement for post-prostatectomy incontinence.

Methods: Thirty-seven patients underwent placement of an ATUS from 2008 to 2010. Patients with and without a history of preoperative XRT were retrospectively compared in regard to their demographical, preoperative, perioperative, and postoperative details.

Results: The median follow-up was 17.3 months. Preoperative pad usage was significantly higher in the XRT patient group (P = .03). Overall, 19 patients (51.4%) used no pads, 10 patients (27.0%) were improved, 4 patients (10.8%) had no change, and 4 patients (10.8%) experienced worsening incontinence after the surgery. In patients with and without a history of XRT, 0 (0%) and 19 (63.3%) used no pads, 2 (28.6%) and 8 (26.7%) were improved, 2 (28.6%) and 2 (6.7%) showed no change, and 3 (42.9%) and 1 (3.3%) were worse, respectively. In comparing patients with more severe incontinence preoperatively (>1 pad/day), those with and without radiation, 0 (0%) and 7 (46.7%) used no pads, 2 (28.6%) and 7 (46.7%) were improved, 2 (28.6%) and 0 (0%) had no change, and 3 (42.9%) and 1 (6.7%) were worse, respectively, after ATUS placement. Thus, patients without XRT had an advantage in postoperative pad usage (P = .001), and, furthermore, had improved quality of life (86.2% vs 28.6%, P = .006).

Conclusion: The ATUS provides excellent continence outcomes in patients suffering from post-prostatectomy urinary incontinence. However, previous pelvic irradiation seems to severely compromise the effectiveness of the ATUS.

MeSH terms

  • Absorbent Pads
  • Aged
  • Humans
  • Male
  • Middle Aged
  • Prostatectomy / adverse effects*
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / surgery
  • Radiotherapy, Adjuvant / adverse effects
  • Retrospective Studies
  • Severity of Illness Index
  • Suburethral Slings*
  • Urinary Incontinence, Stress / etiology
  • Urinary Incontinence, Stress / surgery*
  • Urodynamics