Although radiation history is recognized as a significant risk factor for adverse outcomes following AUS implantation, this long-standing treatment remains the gold standard option for all male patients with refractory stress urinary incontinence (SUI). There remains limited – if any – data on the timing of radiation therapy in relation to outcomes following device implantation. Here, we compare artificial urinary sphincter (AUS) outcomes in post-prostatectomy patients who received radiotherapy in the adjuvant or salvage setting and hypothesize that patients who undergo salvage radiation have poorer overall AUS survivability.
A multicenter retrospective analysis was performed of post-prostatectomy patients with a history of radiation therapy in the adjuvant or salvage setting who also underwent AUS placement for SUI. Clinical characteristics, operative details and surgical outcomes were compared between patients who underwent adjuvant and salvage radiation and a critical analysis of AUS survivability was assessed for both radiation cohorts.
A total of 221 patients met inclusion criteria. The adjuvant radiation cohort consisted of 93 patients (n=42%) and 128 patients (n=58%) underwent salvage radiation with a median follow-up of 26 and 34 months since AUS placement, respectively. Patients with a history of adjuvant therapy had longer interval from radiotherapy to AUS placement (90 v. 48 months, p<0.001). Operative details including total surgery time, incision type and urethral cuff size were similar between the two cohorts (p>0.05). Although overall rate of AUS erosion did not differ with respect to radiation timing (15% v. 18%, p=0.23), median time to AUS explantation was significantly shorter in the salvage cohort (18 v. 26.5 months, p=0.002, Figure 1). There was also a higher rate of post-explantation urethral strictures in patients who received salvage radiation (6/23 v. 1/14, p=0.034).
This is the first multi-institutional series to critically demonstrate a shorter interval of AUS survivability in salvage radiation prostate cancer survivors compared to those with a history of adjuvant radiation.
