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Pelvic radiotherapy does not increase the complication rates of artificial urinary sphincter implantation
Abstract   Peer reviewed

Pelvic radiotherapy does not increase the complication rates of artificial urinary sphincter implantation

H.H Lai, C.P Smith, B.S Teh, E.B Butler and T.B Boone
International journal of radiation oncology, biology, physics, Vol.57(2 Suppl), pp.S273-S273
2003
DOI: 10.1016/S0360-3016(03)01118-0

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Abstract

Purpose/Objective: It is unclear whether pelvic radiotherapy (XRT) increases the complication rates of artificial urinary sphincter (AUS) implantation for intrinsic sphincter deficiency (ISD), as two recent publications revealed conflicting results (Walsh IK et al. BJU Int 2002;89(4):364–8 and Gomha MA, Boone TB. J Urol 2002;167(2 Pt 1):591–6). We present the largest retrospective study to date to clarify the issue. Materials/Methods: From November 1992 to May 2002, 150 patients had AUS (American Medical Systems 800) surgery by a single surgeon (TBB). Fifty patients had a history of pelvic XRT (primary XRT for prostate carcinoma in 18, neoadjuvant XRT prior to radical prostatectomy (RP) in 2, adjuvant XRT after RP in 29, salvage XRT after RP and AUS in 1). One hundred patients had no history of pelvic XRT. Patient demographics, pre-operative urodynamics and complications were retrospectively reviewed and compared between the two groups. Results: Median follow-up was 18.7 (range 1.0 to 104.9) and 20.5 (range 1.0 to 113.4) months in the XRT and non-XRT groups respectively. Patient age, history of collagen injection, pre-operative pad use, post-operative pad use, and post-operative detrusor instability were comparable between the two groups. XRT patients had smaller bladder capacity, earlier sensation and lower detrusor compliance than non-XRT patients in pre-operative urodynamics. Sixty-one- to 70-cm reservoirs were used in all patients except one in each group. To eliminate referral bias, all third-party complications, which resulted in AUS revision or removal (by TBB), were excluded. Pelvic XRT did not increase the complication rates of AUS for ISD, as shown in the table. Conclusions: Radiotherapy to the prostate or prostatic bed does not increase the complication rates of artificial urinary sphincters implantation for intrinsic sphincter deficiency. XRT patients had smaller bladder capacity and lower detrusor compliance than non-XRT patients. Patients have similar outcome with regard to complications and post-operative continence whether or not they have received previous pelvic radiation.

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