Outcomes of artificial urinary sphincter implantation in the irradiated patient
Niranjan J. Sathianathen, Sean M. McGuigan* and Daniel A. Moon*
Faculty of Medicine, Nursing and Health Sciences, Monash University, and *Epworth HealthCare, Melbourne, Vic., Australia
• 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.
• 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.
• 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.