Outcomes of artificial urinary sphincter implantation in the irradiated patient

Abstract

Objectives: To present the outcomes of men undergoing artificial urinary sphincter (AUS) implantation. To determine the impact a 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 AUS implantation for stress urinary 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 with those of men who had undergone radical prostatectomy alone. The effect of co-existing 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%). 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 between the groups. 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 used. There were poorer outcomes in patients with diabetes, and a greater re-operation rate in those men who underwent a transverse scrotal rather than perineal surgical approach, although the differences did not reach statistical significance.

Conclusions: Previous irradiation in patients may increase the complexity of treatment because of a greater incidence of co-existing urethral stricture disease; however, these patients are still able to achieve a level of social continence similar to that of non-irradiated patients, with no discernable increase in complication rates, cuff erosion or the need for revision surgery. AUS implantation remains the 'gold standard' for management of moderate-to-severe stress urinary incontinence in both irradiated and non-irradiated patients after prostate cancer treatment.

Keywords: artificial urinary sphincter; incontinence; prostatectomy; prosthesis; radiation; stricture.