Evaluating the impact of radiation therapy on patient quality of life following primary artificial urinary sphincter placement

Patient Risk Factors and Their Association with Patient Reported Urinary Quality of Life following Artificial Urinary Sphincter Placement: A Paired Pre-and Post-operative Analysis

OBJECTIVE

To evaluate the associations between patient risk factors and incontinence related patient-reported outcome measures (PROMs) pre-and-post artificial urinary sphincter (AUS) implantation. We hypothesize patient risk factors, including prior radiation and diabetes will have a negative association with post AUS PROMs.

METHODS

A review of prospectively collected pre-and-post-operative Incontinence Symptom Index [ISI] and Incontinence Impact Questionnaire-7 (IIQ-7)s from multiple institutions in the Trauma and Urologic Reconstruction Network of Surgeons was performed. Changes in pre-and-post AUS ISI and IIQ-7 scores were compared for the entire cohort then stratified by patients with prior AUS, obesity, diabetes, prior radiation, and mixed urinary incontinence.

RESULTS

A total of 145 patients, 67.2 (SD 10.9) years had complete pre-and-post AUS questionnaires (median follow up 186 days, IQR 136-362). Post AUS ISI and IIQ-7 scores improved significantly for the group at large. Prior radiation was associated with less improvement in total IIQ-7 scores, -25.5 (31.9) vs. -39 (33.0), p=0.03. Obesity was associated with a greater reduction in incontinence severity -13.6 (SD 9.1) vs. -9.2 (SD 8.9), P<0.01, urge -5.2(SD 4.2) vs. -2.5(SD 4.5), p <0.01, and total ISI score -29.7(SD19.7) vs. -21.2 (SD 19.9), p=0.02. Prior AUS, diabetes, and mixed incontinence were not associated with post AUS PROMs outcome.

CONCLUSION

Overall, patients reported a significant reduction in incontinence severity, bother, impact, and distress post AUS placement. Prior radiation was associated with less improvement in total IIQ-7 scores. In contrast, obesity demonstrated a greater reduction in ISI severity and urge scores compared to non-obese patients.

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

AIMS

To evaluate the impact of an history of radiation therapy on the outcomes of artificial urinary sphincter (AUS) implantation in male patients.

METHODS

The charts of all patients who underwent AUS implantation for stress urinary incontinence (SUI) after prostate surgery in thirteen centers between 2004 and 2020 were retrospectively reviewed. We excluded patients with neurogenic SUI. Continence rates and incidence of complications, revision and cuff erosion were evaluated. The outcomes in irradiated men were compared to those of non irradiated men.

RESULTS

A total of 1277 patients who had an AUS met the inclusion criteria with a median age of 70 years, of which 437 had an history of prior radiotherapy. There was no difference in comorbidities. In irradiated patients, postoperative social continence, urethral atrophy and infection rates were respectively 75.6%, 2.4% and 9.5% and 76.8%, 5.4%, and 5.8% in nonirradiated men (respectively, p = 0.799, p = 0.128, p = 0.148). There were more urethral erosion in irradiated male patients. After a mean follow up of 36.8 months, the explantation free survival was poorer in irradiated patients (p = 0.001).

CONCLUSION

These data suggest that pelvic radiotherapy before AUS adversely affect device survival with and increased greater occurrence of infection-erosion and therefore of explantation.