PURPOSE: Although long-term outcomes after initial placement of artificial urinary sphincters (AUS) are established, limited data comparing sphincter survival in patients with compromised urethras (prior radiation, AUS placement, or urethroplasty) exists. We evaluated AUS failure in patients with compromised and non-compromised urethras.
MATERIALS AND METHODS: A retrospective analysis of 86 sphincters placed at a single institution between December 1997 and September 2012 was performed. We assessed patient demographic, comorbid disease and surgical characteristics. All non-functioning, eroded or infected devices were considered failures.
RESULTS: Of the 86 patients reviewed, 67 patients (78%) had compromised urethras and had higher failure rates than the non-compromised group (34% vs. 21%, p=0.02). Compared to the non-compromised group, prior radiation therapy (Hazard Ratio 4.78 (95% Confidence Interval 1.27, 18.04)), urethroplasty (HR 8.61 (95%CI 1.27, 58.51)) and previous AUS placement (HR 8.14 (95%CI 1.71, 38.82)) had a significantly increased risk of failure. The risk of AUS failure increased with more prior procedures. An increased risk of failure was observed after 3.5cm cuff placement (HR 8.62 (95%CI 2.82, 26.36)) but not transcorporal placement (HR 1.21 (95%CI 0.49, 2.99)).
CONCLUSIONS: AUS placement in patients with compromised urethras from prior AUS placement, radiation, or urethroplasty had a statistically significant higher risk of failure than placement in patients with non-compromised urethras. Urethral mobilization and transection performed during posterior urethroplasty surgeries likely compromises urethral blood supply, predisposing patients to failure. Patients with severely compromised urethras from multiple prior procedures may have improved outcomes with transcorporal cuff placement, rather than a 3.5cm cuff.
Written by:
McGeady JB, McAninch JW, Truesdale MD, Blaschko SD, Kenfield S, Breyer BN. Are you the author?
University of California San Francisco, Department of Urology; Urologic Specialists of Oklahoma, Tulsa.
Reference: J Urol. 2014 Jul 8. pii: S0022-5347(14)03932-9.
doi: 10.1016/j.juro.2014.06.088
PubMed Abstract
PMID: 25014577
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