Complications following artificial urinary sphincter placement after radical prostatectomy and radiotherapy: a meta‐analysis

Abstract

ObjectiveTo conduct a systematic review and meta-analysis of artificial urinary sphincter (AUS) placement after radical prostatectomy (RP) and external beam radiotherapy (EBRT). Patients and MethodsThere were 1 886 patients available for analysis of surgical revision outcomes and 949 for persistent urinary incontinence (UI) outcomes from 15 and 11 studies, respectively. The mean age (SD) was 66.9 (1.4) years and the number of patients per study was 126.6 (41.7). The mean (SD, range) follow-up was 36.7 (3.9, 18-68) months. A systematic database search was conducted using keywords, according to Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. Published series of AUS implantations were retrieved, according to the inclusion criteria. The Newcastle-Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA â statistical software. ResultsAUS revision was higher in RP + EBRT vs RP alone, with a random effects risk ratio of 1.56 (95% confidence interval [CI] 1.02-2.72; P < 0.050; I 2 = 82.0%) and a risk difference of 16.0% (95% CI 2.05-36.01; P < 0.080). Infection/erosion contributed to the majority of surgical revision risk compared with urethral atrophy (P = 0.020). Persistent UI after implantation was greater in patients treated with EBRT (P < 0.001). ConclusionsMen receiving RP + EBRT appear at increased risk of infection/erosion and urethral atrophy, resulting in a greater risk of surgical revision compared with RP alone. Persistent UI is more common with RP + EBRT.

Long-term Outcomes Following Artificial Urinary Sphincter Placement: An Analysis of 1082 Cases at Mayo Clinic

“…[13][14][15][16] It is hypothesized that adverse device outcomes following radiation therapy may be secondary to peri-urethral tissue damage, decreased tissue vascularity and poor wound healing. Certainly this is consistent with a recent multi-institutional series demonstrated increased infection/erosion rates in patients with prior radiation therapy.…”

Male urinary incontinence: Artificial sphincter

“…After the analysis of the full texts, 17 studies were included in our evaluation. 16,18,24,36,[38][39][40][41][42][43][44] The main reason for exclusion was lack of response to the PICO.…”

Vyrų šlapimo nelaikymo gydymas implantuojant dirbtinį sfinkterį AMS 800

“…Radioterapija susijusi su endarteritu, lėtiniais kraujagyslių pakitimais, kurie gali sutrikdyti šlaplės kraujotaką ir sukelti atrofiją. Taip pat yra nustatyta, kad pacientai, kuriems taikyta radioterapija prieš dirbtinio sfinkterio implantavimo operaciją, turi didesnę erozijos, pakartotinės operacijos riziką [57][58][59][60]. Šiems pacientams rekomenduojamas mažesnio slėgio balionas, 6 savaitėms atidėtas prietaiso aktyvavimas.…”

“…Pakartotinių operacijų dėl prietaiso sukeltų komplikacijų dažnis yra apie 25 % [59]. Literatūros duomenimis, 5 metų prietaiso veikimo laikas įvairuoja nuo 59 % 79 %, 10 metų veikimo laikas -nuo 28 % iki 64 %, o 15 metų -nuo 15 % iki 41 % [61][62][63].…”