The impact of incontinence etiology on artificial urinary sphincter outcomes

• Published in: Investigative and clinical urology 2017, 58(4), , pp.241-246
• Main Authors: Miller, Adam R, Linder, Brian J, Rangel, Laureano J, Yang, David Y, Elliott, Daniel S
• Format: Article
• Language: English
• Subjects: Aged; Artificial urinary sphincter; Male; Urinary bladder; Urinary incontinence; Cryotherapy - adverse effects; Humans; Kaplan-Meier Estimate; Male; Multivariate Analysis; Neoplasm Recurrence, Local - complications; Original; Prostatectomy - adverse effects; Prostatic Neoplasms - complications; Prostatic Neoplasms - mortality; Prostatic Neoplasms - surgery; Prosthesis-Related Infections - etiology; Retrospective Studies; Risk Factors; Salvage Therapy - methods; Treatment Outcome; Urinary Incontinence - etiology; Urinary Incontinence - mortality; Urinary Sphincter, Artificial; 비뇨기과학
• ISSN: 2466-0493; 2466-054X
• DOI: 10.4111/icu.2017.58.4.241

To evaluate the impact of incontinence etiology on artificial urinary sphincter (AUS) device outcomes. We identified 925 patients who underwent primary AUS placement from 1983 to 2011. The etiology of incontinence was categorized as radical prostatectomy alone, radical prostatectomy with radiation, benign prostate resection, and those with cryotherapy as a salvage prostate cancer treatment. Hazard regression and competing risk analyses were used to determine the association of the etiology of incontinence with device outcomes. The distribution of the 4 etiologies of incontinence included: 598 patients (64.6%) treated with prostatectomy alone, 206 (22.2%) with prostatectomy and pelvic radiation therapy, 104 (11.2%) with benign prostate resection, and 17 (1.8%) with prior cryotherapy. With a median follow-up of 4.9 years (interquartile range, 1.2-8.8 years), there was significant difference in the cumulative incidence of device infection/urethral erosion events between the four etiologies (p=0.003). On multivariable analysis, prior cryotherapy (reference prostatectomy alone; hazard ratio [HR], 3.44; p=0.01), older age (HR, 1.07; p=0.0009) and history of a transient ischemic attack (HR, 2.57; p=0.04) were associated with an increased risk of device infection or erosion. Notably, pelvic radiation therapy with prostatectomy was not associated with an increased risk of device infection or erosion (reference prostatectomy alone, p=0.30). Compared to prostatectomy alone, prior treatment with salvage cryotherapy for recurrent prostate cancer was associated with an increased risk of AUS infection/erosion, whereas radiation (in addition to prostatectomy) was not.