Investig Clin Urol.  2017 Jul;58(4):241-246. 10.4111/icu.2017.58.4.241.

The impact of incontinence etiology on artificial urinary sphincter outcomes

Affiliations
  • 1Department of Urology, Mayo Clinic, Rochester, MN, USA. Elliott.Daniel@mayo.edu
  • 2Health Sciences Research, Mayo Clinic, Rochester, MN, USA.

Abstract

PURPOSE
To evaluate the impact of incontinence etiology on artificial urinary sphincter (AUS) device outcomes.
MATERIALS AND METHODS
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.
RESULTS
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).
CONCLUSIONS
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.

Keyword

Artificial urinary sphincter; Male; Urinary bladder; Urinary incontinence

MeSH Terms

Cryotherapy
Follow-Up Studies
Humans
Incidence
Ischemic Attack, Transient
Male
Prostate
Prostatectomy
Prostatic Neoplasms
Urinary Bladder
Urinary Incontinence
Urinary Sphincter, Artificial*

Figure

  • Fig. 1 Kaplan-Meier curve of overall device survival stratified by radical prostatectomy (RP), radical prostatectomy with radiation (RP+RT), benign prostate resection (TURP), and cryotherapy as a salvage prostate cancer treatment (Cryo). AUS, artificial urinary sphincter.

  • Fig. 2 Cumulative incidence curves for secondary surgery, stratified by etiology of incontinence for device infection/erosion (A), mechanical failure (B), and urethral atrophy (C). RP, radical prostatectomy; RP + RT, radical prostatectomy with radiation; TURP, benign prostate resection; Cryo, prior cryotherapy as salvage treatment.


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