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

OBJECTIVE

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 5-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 2 groups (18.8% vs 25.2%, P=.761).

CONCLUSION

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