Introduction: Prior data suggests radiation is associated with shorter artificial urinary sphincter (AUS) device survival. However, there is a paucity of data on outcomes of patients undergoing radiation after AUS. We aimed to compare AUS outcomes between patients receiving prostate radiation before or after AUS.
Methods: We performed an IRB-approved chart review of all men in our Research Patient Data Registry who underwent AUS, radical prostatectomy and prostate radiation from 1989-2019. Patients were grouped by radiation before or after AUS and clustered by surgeon. Our primary outcomes were diagnosis of urethral atrophy (recurrent incontinence with functional device), revision surgery for atrophy and time to these outcomes. Time to outcome was calculated from date by which patients had received both AUS and radiation. We performed multivariable logistic and Cox proportional hazard survival analyses.
Results: Of 154 patients, 137 (89%) had radiation a median 48 mo (3-267) prior to AUS and 17 (11%) had radiation after AUS at median 16.5 mo (2-77). There was no difference in age, race, Charlson Comorbidity Index, smoking, diabetes, prior sling, bulking agent, bladder neck contracture, androgen deprivation, or AUS cuff size between groups. Median follow-up post-exposure was 25 (0-216) mo. Atrophy occurred in significantly more men in the radiation after AUS group (47% v 10%, p=<0.001) at median 12.0 v 35.5 mo (p=0.04). There was no difference in urologic complications, erosion, explant or revision. On multivariable regression, receipt of radiation after AUS was associated with atrophy (OR 6.73, p<0.001). Multivariable survival analysis revealed those with radiation after AUS developed atrophy earlier (HR 4.02, p=0.04) with a shorter time to revision for atrophy (HR 9.2, p=0.003).
Conclusions: We found post-AUS radiation is associated with atrophy, as well as shorter time to atrophy and revision for atrophy. This suggests that if radiation is anticipated, urologists should consider waiting until radiation is complete before AUS insertion. Source of
