The artificial urinary sphincter (AUS) is the gold standard treatment for refractory post-prostatectomy incontinence. Poorer outcomes (including risk of device erosion and infection) have been observed in those with history of pelvic radiation. However, the impact of radiation timing (i.e. radiation prior to versus after AUS placement) has not been well-studied. We aimed to clarify the impact of radiation timing on AUS outcomes by comparing those who underwent AUS placement before or after radiation therapy.
Retrospective review of patients undergoing virgin AUS placement for post-prostatectomy incontinence from 1/1/2017 to 12/31/22 at a single center was performed. Patients were stratified based on treatment sequence into those who had radiation prior to AUS placement (pre-AUS) and those who had radiation following AUS placement (post-AUS). Outcomes including rates of continence (defined as ≤1 pad per day), infection, device erosion, and need for revision surgery were evaluated.
Of 362 post-prostatectomy patients undergoing AUS placement, 176 had pre-AUS radiation and 18 had post-AUS radiation. Outcomes are listed in Table 1. Patients were slightly younger in the post-AUS group (p=.005); other characteristics were similar. Mean cuff size was also similar between the two groups. Highest continence rates were observed in the post-AUS group (p=.029). Of those with at least 180-day follow-up, no patients in the post-AUS group experienced erosion or infection, versus 12/124 (9.7%) and 12/124 (9.7%) in the pre-AUS group, respectively. While pre-AUS patients had a higher frequency of revision surgery, the difference was not statistically significant (p=.074).
Patients undergoing radiation after AUS placement were more likely to achieve continence and experienced similar complication rates compared to those having undergone radiation before AUS placement. This data could help counsel incontinent men considering radiation treatment after prostatectomy.
