Presentation Authors: William Boysen*, Brittany Adamic, Chicago, IL, Kristine Kuchta, Sangtae Park, Evanston, IL
Introduction: Urinary incontinence (UI) is a common and bothersome symptom among men undergoing orthotopic bladder substitution (OBS) following radical cystectomy (RC). Institutional series report that artificial urinary sphincter (AUS) utilization is rare in this population. We sought to characterize trends in AUS utilization, determine factors associated with AUS placement, and assess long term device outcomes at the population level.
Methods: Using the 2004-2014 SEER Medicare database, we identified all men older than 65 treated with RC for bladder cancer. Clinical and demographic data were collected, and AUS placement was determined by CPT code. Device survival was defined as freedom from reoperation and assessed using CPT codes. A propensity-matched cohort of men undergoing AUS placement after prostatectomy was generated for comparison.
Results: A total of 3442 men underwent RC, with 936 undergoing OBS reconstruction (27.2%). Subsequent AUS placement occurred in 35 men (3.7%) at a median of 26 months after RC. Men undergoing AUS were younger (mean age 71.4 versus 73.3 years, p=0.03), but the cohorts did not differ with respect to race, marital status, median income, cancer stage, or Charlson comorbidity index. On multivariable analysis, increasing age was associated with decreased odds of AUS placement (OR 0.91, 95%CI 0.84-0.98, p=0.01) while residence in SEER west region was associated with increased odds of AUS placement (OR 2.70, 95%CI 1.22-5.97, p=0.01). At 1- and 5-years respectively, device survival was 85.6% and 75.9%. On Kaplan-Meier analysis, there was no difference in long term device survival when compared to a propensity-matched cohort of patients undergoing AUS after prostatectomy (Figure 1, p=0.4). Overall complication rate was equivalent 30-days after AUS (14.3% vs 13.1%, p=0.79), but higher in the post-cystectomy cohort at 90-days (42.9% vs 24.0%, p=0.04).
Conclusions: AUS placement is rare following RC with OBS in the SEER-Medicare population (3.7%). Younger age is associated with AUS utilization and there are geographical disparities in utilization. Long term device survival is equivalent to the post-prostatectomy population, but higher complication rates may be due to the complexities of AUS placement in this unique population.