Introduction & Objectives: 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 four etiologies of incontinence included: 598 patients treated with prostatectomy alone (64.6%), 206 with prostatectomy and pelvic radiation therapy (22.2%), 104 with benign prostate resection (11.2%), and 17 with prior cryotherapy (1.8%). Patients treated with cryotherapy had a higher BMI (p=0.03) and more commonly had coronary artery disease (p=0.001) than the other cohorts. With a median follow-up of 4.9 years (IQR 1.2, 8.8), 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 (ref. prostatectomy alone, 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 (ref. 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.
