Impact of Adjuvant Radiation on Artificial Urinary Sphincter Durability in Postprostatectomy Patients

Srivastava, Arnav; Joice, Gregory; Patel, Hiten D.; Manka, Madeleine; Sopko, Nikolai A.; Wright, E. James

doi:10.1016/j.urology.2017.12.029

Cited by 18 publications

(21 citation statements)

References 15 publications

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“…The results of the search strategy and the number of records at each stage are presented in Figure 1. A total of 18 studies met the inclusion criteria and were reviewed in our study (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Details of the included studies are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Impact of Radiation Therapy on Outcomes of Artificial Urinary Sphincter: A Systematic Review and Meta-Analysis

Zhang

2022

Front. Surg.

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BackgroundTo compare incontinence rates and complications in patients receiving artificial urinary sphincter (AUS) with or without radiotherapy (RT).MethodsPubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched for studies comparing outcomes of AUS between patients with and without RT. Search limits were from 1st January 2002 to 15th September 2021.ResultsEighteen studies were included. Meta-analysis revealed statistically significant reduced odds of the absence of incontinence in the RT group (OR: 0.35 95% CI: 0.21, 0.59 I2 = 51% p < 0.0001) as compared to the no-RT group. We also noted statistically significant increased risk of revision surgery in the RT group (OR: 1.74 95% CI: 1.16, 2.60 I2 = 73% p = 0.07). There was increased risk of infections (OR: 2.51 95% CI: 1.00, 6.29 I2 = 46% p = 0.05) and erosions (OR: 2.00 95% CI: 1.15, 3.45 I2 = 21% p = 0.01) in the RT group, but the difference was significant only for erosions. Meta-analysis revealed a statistically significant increased risk of explantation in patients with RT (OR: 3.00 95% CI: 1.16, 7.75 I2 = 68% p = 0.02) but there was no difference in the risk of urethral atrophy (OR: 1.18 95% CI: 0.47, 2.94 I2 = 46% p = 0.72) and mechanical failure (OR: 0.90 95% CI: 0.25, 3.27 I2 = 54% p = 0.87) between the two groups.ConclusionsOur meta-analysis of recent studies indicates that RT significantly reduces the odds of achieving complete continence after AUS placement. History of RT does not increase the risk urethral atrophy or mechanical failure in patients with AUS. However, the risk of revision surgery, erosions and explantations is significantly increased in patients with RT with a non-significant but increased tendency of infections.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: NCT02612389.

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Section: Resultsmentioning

confidence: 99%

Impact of Radiation Therapy on Outcomes of Artificial Urinary Sphincter: A Systematic Review and Meta-Analysis

Zhang

2022

Front. Surg.

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“…Previous radiation typically makes dissection more challenging, resulting in a greater risk of short-term and long-term complications (Table 3). The high proportion of patients with prior radiation or surgery in this study highlights how this novel technique is feasible even in patients with fibrotic and scarred tissue (16).…”

Section: Discussionmentioning

confidence: 94%

Single perineal incision for artificial urinary sphincter: analysis of technique, outcomes, and experience

Punjani¹,

Chan²,

Chan³

et al. 2020

Transl Androl Urol

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reported satisfaction rates of 87-90% in long-term followup (3). Since its introduction, use of AUS has also expanded to the management of SUI caused by transurethral procedures, radiation therapy, intrinsic sphincter deficiency, neurogenic bladder, congenital disorders, and orthotopic neobladder urinary diversion (4,5).The standard device, the AMS 800 AUS, is traditionally implanted using a combined perineal and abdominal approach, which requires two incisions: a perineal incision for placement of the cuff, and a suprapubic incision for

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“…Although small, our study represents a more racially and ethnically diverse patient population than many other studies evaluating the impact of AUS placement. Srivastava et al 6 assessed AUS survival and causes of failure in a patient population that was 80% white. Similarly, Kim et al, 7 evaluated long-term durability and functional outcomes of AUS in a patient population that was 86.3% white.…”

Section: Resultsmentioning

confidence: 99%

Overactive bladder and urgency urinary incontinence in men undergoing artificial urinary sphincter placement

Jahromi

Engle

Furlong

et al. 2020

Neurourology and Urodynamics

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Purpose To assess persistent and de novo rates of overactive bladder (OAB) and urgency urinary incontinence (UUI) in patients with incontinence after prostate treatment (IPT) focusing on differences between surgical intervention vs radiation. Methods We performed a retrospective review of 79 patients who underwent primary artificial urinary sphincter (AUS) placement and activation from a single surgeon between February 2012 and November 2017. Four patients with neurogenic bladder were excluded and two with insufficient follow‐up. The primary outcome measures were persistent OAB, persistent UUI, and pad usage before and after AUS placement. Results After activation of the AUS, 67% of non‐radiated patients had resolution of urgency incontinence vs only 31% of the radiated patients (P = .096). After activation of the AUS, resolution of OAB symptoms was more common in the non‐radiated group. We found 53% of the non‐radiated group vs only 22% of the radiated group had resolution of their urinary urgency (P = .045). Previous history of radiation was a risk factor for OAB after implantation of AUS (odds ratio [OR], 3.63; P = .010). Postoperative oral medical pharmacotherapy for OAB was higher in those with previous radiation vs those without prior radiation (66.7% vs 25.7%, P = .001). A history of OAB or UUI did not affect social continence after AUS placement. Conclusion Radiation is a risk for continued OAB after AUS activation. Appropriate counseling is necessary pre‐ and postoperatively to manage patient expectations and provide additional medical therapies. Mixed urinary incontinence or OAB symptoms should not exclude patients from undergoing AUS placement.

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Impact of Adjuvant Radiation on Artificial Urinary Sphincter Durability in Postprostatectomy Patients

Cited by 18 publications

References 15 publications

Impact of Radiation Therapy on Outcomes of Artificial Urinary Sphincter: A Systematic Review and Meta-Analysis

Impact of Radiation Therapy on Outcomes of Artificial Urinary Sphincter: A Systematic Review and Meta-Analysis

Single perineal incision for artificial urinary sphincter: analysis of technique, outcomes, and experience

Overactive bladder and urgency urinary incontinence in men undergoing artificial urinary sphincter placement

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