Artificial Urinary Sphincter Placement Before or After Radiation Therapy: Does Timing of Radiation Impact Surgical Complications and Continence?

Abstract

Objectives: To evaluate the impact of radiation timing on artificial urinary sphincter (AUS) outcomes. AUS is the gold standard treatment for post-prostatectomy incontinence. Radiation history has been associated with worse outcomes, including higher rates of erosion and infection. The impact of radiation timing-before versus after AUS placement-has been less well studied.

Methods: Patients undergoing AUS placement over a five-year period were retrospectively reviewed. Salvage prostatectomy patients were excluded. Patients were stratified by radiation timing: radiation prior to AUS placement (pre-AUS) versus after AUS placement (post-AUS). Outcomes included continence rate, improvement in pads per day, complications, and need for further surgery.

Results: Of 315 post-prostatectomy AUS patients, 181 underwent radiation treatment. Excluding 42 patients for salvage prostatectomy, 123 patients underwent radiation pre-AUS and 16 post-AUS. Patients were slightly younger in the post-AUS group (p=.020); demographics were otherwise similar. Mean cuff size was similar in both groups. Continence rates were not significantly different (p=.509), nor was difference in pad per day improvement (-3.0 ppd for pre-AUS and -3.8 ppd in the post-AUS group (p=.379)). Over a median follow up of 27.7 months, 1/16 (6.6%) patients experienced device erosion in the post-AUS group, compared to 15/123 (12.2%) pre-AUS (median follow up 15.6 months). No patients in the post-AUS group experienced device infection, compared to 6/123 patients in the pre-AUS group. Revision rates were similar between the two groups (18.8% vs 25.2%, p= 0.761).

Conclusions: Patients undergoing AUS placement prior to radiation experienced similar continence improvements and similar complications rates to those who underwent radiation following AUS.