Artificial Urinary Sphincter Placement Before or After Radiation Therapy: Does Timing of Radiation Impact Surgical Complications and Continence?

Emily Bochner; Blake Johnson; Bryce Franzen; Alexandria Hertz; Ethan Matz; Steve Hudak; Maia VanDyke

doi:10.1016/j.urology.2025.01.003

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Artificial Urinary Sphincter Placement Before or After Radiation Therapy: Does Timing of Radiation Impact Surgical Complications and Continence?

Journal article

Peer reviewed

Artificial Urinary Sphincter Placement Before or After Radiation Therapy: Does Timing of Radiation Impact Surgical Complications and Continence?

Emily Bochner, Blake Johnson, Bryce Franzen, Alexandria Hertz, Ethan Matz, Steve Hudak and Maia VanDyke

Urology (Ridgewood, N.J.), Vol.197, pp.185-189

03/01/2025

DOI: 10.1016/j.urology.2025.01.003

PMID: 39827916

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Abstract

To evaluate the impact of radiation timing on artificial urinary sphincter (AUS) outcomes. AUS is the gold standard treatment for post-prostatectomy incontinence. Radiation history has been associated with worse outcomes, including higher rates of erosion and infection. The impact of radiation timing-before versus after AUS placement-has been less well studied. Patients undergoing AUS placement over a 5-year period were retrospectively reviewed. Salvage prostatectomy patients were excluded. Patients were stratified by radiation timing: radiation prior to AUS placement (pre-AUS) versus after AUS placement (post-AUS). Outcomes included continence rate, improvement in pads per day, complications, and need for further surgery. Of 315 post-prostatectomy AUS patients, 181 underwent radiation treatment. Excluding 42 patients for salvage prostatectomy, 123 patients underwent radiation pre-AUS and 16 post-AUS. Patients were slightly younger in the post-AUS group (P=.020); demographics were otherwise similar. Mean cuff size was similar in both groups. Continence rates were not significantly different (P=.509), nor was difference in pad per day improvement (-3.0 ppd for pre-AUS and -3.8 ppd in the post-AUS group (P=.379)). Over a median follow-up of 27.7 months, 1/16 (6.6%) patients experienced device erosion in the post-AUS group, compared to 15/123 (12.2%) pre-AUS (median follow-up 15.6 months). No patients in the post-AUS group experienced device infection, compared to 6/123 patients in the pre-AUS group. Revision rates were similar between the 2 groups (18.8% vs 25.2%, P=.761). Patients undergoing AUS placement prior to radiation experienced similar continence improvements and similar complication rates to those who underwent radiation following AUS.

Aged

Humans

Male

Middle Aged

Postoperative Complications - epidemiology

Postoperative Complications - etiology

Postoperative Complications - surgery

Prostatectomy - adverse effects

Prostatic Neoplasms - radiotherapy

Prostatic Neoplasms - surgery

Prosthesis Implantation - methods

Retrospective Studies

Time Factors

Treatment Outcome

Urinary Incontinence - etiology

Urinary Incontinence - surgery

Urinary Incontinence, Stress - etiology

Urinary Incontinence, Stress - surgery

Urinary Sphincter, Artificial - adverse effects

Details

Title: Subtitle: Artificial Urinary Sphincter Placement Before or After Radiation Therapy: Does Timing of Radiation Impact Surgical Complications and Continence?
Creators: Emily Bochner - The University of Texas Southwestern Medical Center
Blake Johnson - Southwestern University
Bryce Franzen - The University of Texas Southwestern Medical Center
Alexandria Hertz - The University of Texas Southwestern Medical Center
Ethan Matz - The University of Texas Southwestern Medical Center
Steve Hudak - The University of Texas Southwestern Medical Center
Maia VanDyke - The University of Texas Southwestern Medical Center
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.197, pp.185-189
DOI: 10.1016/j.urology.2025.01.003
PMID: 39827916
NLM abbreviation: Urology
ISSN: 0090-4295
eISSN: 1527-9995
Language: English
Date published: 03/01/2025
Academic Unit: Urology
Record Identifier: 9984848421902771

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