Impact of radiation therapy on artificial urinary sphincter implantation in male patients: A multicenter study

Mamane, Jordan; Sanchez, Stéphane; Lellouch, Alexandre G.; Gaillard, Victor; Poussot, Baptiste; Tricard, Thibault; Saussine, C.; Brierre, T.; Gamé, X.; Beraud, Florian; Biardeau, Xavier; Bruyère, F.; Robin, D.; El-Akri, M.; Chevallier, D.; Durand, Mathieu; Bentellis, I.; Cousin, Tiffany; Capon, G.; Cornu, Jean‐Nicolas; Dupuis, H.; Monsaint, Hervé; Corbel, L.; Hermieu, N.; Hermieu, Jean-François; Pitout, Alice; Lecoanet, Pierre; Peyronnet, B.; Léon, Priscilla

doi:10.1002/nau.24825

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…Our study corroborates the prior finding that radiation therapy to the urethra increases the risk of cuff erosion [ 13 ]. Similar results have been reported in other large cohorts [ 9 , 14 ].…”

Section: Discussionsupporting

confidence: 92%

Risk Factors for Artificial Urinary Sphincter Explantation and Erosion in Male Nonneurological Patients

Pitout,

Lecoanet,

Mazeaud

et al. 2024

Int Neurourol J

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Purpose: This study was performed to assess the risk factors for artificial urinary sphincter (AUS) explantation in a large multicenter cohort.Methods: We retrospectively reviewed the medical records for all 1,233 implantations of the AMS-800 AUS device in male nonneurological patients from 2005 to 2020 across 13 French centers. Patients with neurological conditions were excluded from the study. To identify factors associated with explantation-free survival, survival analysis was performed. Explantation was defined as the complete removal of the device, whereas revision referred to the replacement of the device or its components.Results: The study included 1,107 patients, of whom 281 underwent AUS explantation. The median survival without explantation was 83 months. The leading causes of explantation were infection and erosion. Univariate analysis revealed several significant risk factors for explantation: age above 75 years (34.6% in the explanted group vs. 25.8% in the nonexplanted group, P=0.007), history of radiotherapy (43.5% vs. 31.3%, P=0.001), and anticoagulant use (15% vs. 8.6%, P<0.001). In logistic regression analysis, the only significant risk factor was previous radiotherapy (odds ratio [OR], 2.05; P<0.05). Cox proportional hazards analysis revealed 2 factors associated with earlier explantation: transcorporal cuff implantation (hazard ratio [HR], 2.67; P=0.01) and the annual caseload of the center (HR, 1.08; P=0.02). When specifically examining explantation due to erosion, radiotherapy was the sole factor significantly associated with the risk of erosion (OR, 2.47; P<0.05) as well as earlier erosion (HR, 1.90; P=0.039).Conclusions: In this series, conducted in a real-world setting across multiple centers with different volumes and levels of expertise, the median survival without AUS explantation was 83 months. This study confirms that radiotherapy represents the primary independent risk factor for AUS erosion in male nonneurological patients.

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Section: Discussionsupporting

confidence: 92%

Risk Factors for Artificial Urinary Sphincter Explantation and Erosion in Male Nonneurological Patients

Pitout,

Lecoanet,

Mazeaud

et al. 2024

Int Neurourol J

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“…Similarly, the effectiveness of AUS is reduced in radiated patients 21 . Besides, the histological alterations produced by radiation increase the risk of surgical revision due to urethral atrophy and erosion produced by the circumferential dissection of the urethral bulb for AUS implantation 22,23 …”

Section: Discussionmentioning

confidence: 99%

“…21 Besides, the histological alterations produced by radiation increase the risk of surgical revision due to urethral atrophy and erosion produced by the circumferential dissection of the urethral bulb for AUS implantation. 22,23 Irradiated patients may also suffer from the condition termed 'devastated bladder outlet', used to describe the combination of stress incontinence and stenosis of the membranous urethra and/or bladder neck. Classical management in these cases includes endoscopic treatment or stricture reconstruction followed by late AUS implantation in the absence of restenosis.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of adjustable trans‐obturator male system (ATOMS) in radiated patients is reduced: A propensity score‐matched analysis

Angulo,

Giammò,

Queissert

et al. 2024

BJUI Compass

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ObjectivesThis study aimed to compare the effectiveness and safety of the adjustable trans‐obturator male system (ATOMS®) to treat post‐prostatectomy incontinence (PPI) in radiated patients compared with non‐radiated patients, using propensity score‐matching analysis to enhance the validity of the comparison.Patients and methodsConsecutive men with PPI treated with silicone‐covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24‐h pad usage, urethroscopy and urodynamics, if indicated. Propensity score‐matching analysis was based on age, length of follow‐up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post‐operatively with a security pad allowed. The secondary endpoints were complications, device removal and self‐perceived satisfaction with the Patient Global Impression of Improvement (PGI‐I) scale.ResultsOf the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24‐h pad was 4.8 in both groups (p = 0.48). The mean follow‐up was 27.5 ± 18.6 months, which was also equivalent between groups (p = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non‐radiated patients (p < 0.0001). The mean pad count at the last follow‐up was 1.5 and 0.8, respectively (p < 0.0001). There was no significant difference in complications (p = 0.94), but surgical revision and device explant rates were higher (p = 0.03 and p = 0.01, respectively), and the proportion of patients highly satisfied (PGI‐I = 1) was lower in the radiated group (p = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias.ConclusionATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.

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“…Prior studies have examined risk factors associated with AUS cuff erosion, with the vast majority being single-center retrospective studies with small cohorts (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Previously described risk factors include diabetes, smoking status, obesity, coronary artery disease, previous urethroplasty, history of radiation, and previous AUS cuff erosion.…”

Section: Bulbar Urethral Compromise Prior Aus Cuff Erosionmentioning

confidence: 99%

“…This erosion risk is higher among patients with a history of pelvic radiation, with rates reported as high as 33.3% (range, 3.4-33.3%) (7)(8)(9)(10)(11)(12)(13)(14)(15). Numerous studies have examined AUS revision and erosion in irradiated patients, with mixed results (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The vast majority of these studies are single-center and retrospective in nature and often include patients with multiple comorbidities such as history of urethroplasty or previous AUS erosion, which may further increase their risk of AUS complications.…”

Section: Prior Pelvic Radiotherapymentioning

confidence: 99%

Management of male stress urinary incontinence in high-risk patients: a narrative review

Lin¹,

Skokan²,

Wessells³

et al. 2023

Transl Androl Urol

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Background and Objectives: The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients.Methods: A comprehensive review of current literature was performed utilizing the search term "artificial urinary sphincter" in conjunction with any of the following additional terms: "radiation", "urethral stricture", "posterior urethral stenosis", "vesicourethral anastomotic stenosis", "bladder neck contracture", "pelvic fracture urethral injury", "penile revascularization", "inflatable penile prosthesis", and "erosion". Guidance is provided based upon expert opinion where existing literature was sparse or nonexistent.Key Content and Findings: Several known patient risk factors are associated with AUS failure and can ultimately lead to device explantation. Each risk factor requires careful consideration and investigation, or intervention as appropriate, prior to device placement. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients. Several surgical strategies to decrease device complications can be considered: optimization of testosterone, avoidance of 3.5 cm AUS cuff, transcorporal AUS cuff placement, relocation of AUS cuff site, use of lower pressure-regulating balloon, penile revascularization, and intermittent nocturnal deactivation.Conclusions: A number of patient risk factors are associated with AUS failure and can ultimately lead to device explantation. We present an algorithm for management of high-risk patients. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients.

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Impact of radiation therapy on artificial urinary sphincter implantation in male patients: A multicenter study

Cited by 14 publications

References 25 publications

Risk Factors for Artificial Urinary Sphincter Explantation and Erosion in Male Nonneurological Patients

Risk Factors for Artificial Urinary Sphincter Explantation and Erosion in Male Nonneurological Patients

The effectiveness of adjustable trans‐obturator male system (ATOMS) in radiated patients is reduced: A propensity score‐matched analysis

Management of male stress urinary incontinence in high-risk patients: a narrative review

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