Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence

Guillaumier, Stephanie; Solomon, Eskinder; Jenks, Julie; Pakzad, Mahreen; Hamid, Rizwan; Ockrim, Jeremy; Shah, Julian; Greenwell, Tamsin

doi:10.4103/ua.ua_25_17

Cited by 18 publications

(11 citation statements)

References 35 publications

(58 reference statements)

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“…[5][6][7][8] In contrast, other studies reported that a history of RT was associated with significantly worse outcomes, including continent status and complications after AUS implantation. [9][10][11][12][13] To date, there have been no studies investigating the impact of a history of pelvic RT on LUTS other than UI after AUS implantation.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies demonstrated that there were no significant differences in urge incontinence, QOL, and complications after AUS implantation between patients with and without a history of pelvic RT 5–8 . In contrast, other studies reported that a history of RT was associated with significantly worse outcomes, including continent status and complications after AUS implantation 9–13 …”

Section: Introductionmentioning

confidence: 99%

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Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy

Kataoka,

Yokoyama,

Waseda

et al. 2023

LUTS

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ObjectivesTo evaluate longitudinal changes in lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation in patients undergoing radiation therapy (RT) in comparison to those in non‐irradiated patients.MethodsThis retrospective study included 20 and 51 patients with and without a history of pelvic RT (RT and non‐RT group, respectively) who were treated with primary AUS implantation for post‐radical prostatectomy incontinence between 2010 and 2020. Longitudinal changes in the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), the International Prostate Symptom Score (IPSS), and the Overactive Bladder Symptom Score (OABSS) were calculated with a linear mixed model.ResultsIn the RT and non‐RT group, 18 (90%) and 48 (94%) patients achieved social continence, defined as daily pad use ≤1 at 1 month after activation of AUS, respectively (p = .555). During the mean follow‐up of 38 months, ICIQ‐SF, IPSS, and OABSS significantly improved after AUS implantation in both the RT and non‐RT groups. In the RT group, ICIQ‐SF, IPSS, and OABSS subsequently deteriorated with a slope of 0.62/year (p = .010), 0.55/year (p = .025), and 0.30/year (p = .007), respectively. In the non‐RT group, no significant longitudinal changes in subsequent IPSS and OABSS were observed, although ICIQ‐SF significantly deteriorated (0.43/year, p = .006). Comparing between the groups, the slopes of IPSS and OABSS were significantly greater in the RT group than in the non‐RT group (p < .001, and .015, respectively).ConclusionsLongitudinal deterioration in LUTS that improved immediately after AUS implantation was observed in patients with a history of pelvic RT, but not in patients without a history of pelvic RT.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy

Kataoka,

Yokoyama,

Waseda

et al. 2023

LUTS

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“…19,20 Similarly, the effectiveness of AUS is reduced in radiated patients. 21 Besides, the histological alterations produced by radiation increase the risk of surgical revision due to urethral atrophy and erosion produced by the circumferential dissection of the urethral bulb for AUS implantation. 22,23 Irradiated patients may also suffer from the condition termed 'devastated bladder outlet', used to describe the combination of stress incontinence and stenosis of the membranous urethra and/or bladder neck.…”

Section: Discussionmentioning

confidence: 99%

“…Fixed retro‐urethral slings are not recommended for the very high rate of incontinence recurrence due to inadequate urethral closure caused by urethral and periurethral fibrosis 19,20 . Similarly, the effectiveness of AUS is reduced in radiated patients 21 . Besides, the histological alterations produced by radiation increase the risk of surgical revision due to urethral atrophy and erosion produced by the circumferential dissection of the urethral bulb for AUS implantation 22,23 …”

Section: Discussionmentioning

confidence: 99%

The effectiveness of adjustable trans‐obturator male system (ATOMS) in radiated patients is reduced: A propensity score‐matched analysis

Angulo,

Giammò,

Queissert

et al. 2024

BJUI Compass

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ObjectivesThis study aimed to compare the effectiveness and safety of the adjustable trans‐obturator male system (ATOMS®) to treat post‐prostatectomy incontinence (PPI) in radiated patients compared with non‐radiated patients, using propensity score‐matching analysis to enhance the validity of the comparison.Patients and methodsConsecutive men with PPI treated with silicone‐covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24‐h pad usage, urethroscopy and urodynamics, if indicated. Propensity score‐matching analysis was based on age, length of follow‐up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post‐operatively with a security pad allowed. The secondary endpoints were complications, device removal and self‐perceived satisfaction with the Patient Global Impression of Improvement (PGI‐I) scale.ResultsOf the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24‐h pad was 4.8 in both groups (p = 0.48). The mean follow‐up was 27.5 ± 18.6 months, which was also equivalent between groups (p = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non‐radiated patients (p < 0.0001). The mean pad count at the last follow‐up was 1.5 and 0.8, respectively (p < 0.0001). There was no significant difference in complications (p = 0.94), but surgical revision and device explant rates were higher (p = 0.03 and p = 0.01, respectively), and the proportion of patients highly satisfied (PGI‐I = 1) was lower in the radiated group (p = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias.ConclusionATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.

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“…Some patient characteristics may influence efficacy outcomes, such as the cure, improvement and failure rates at the number of pads per day. First, we hypothesize that patients who received pelvic radiotherapy will have worse outcomes than non-irradiated patients due to fibrosis and scarring 40 – 42 . Second, we hypothesize that patients suffering from severe PPI will have worse outcomes following continence surgery than patients suffering from mild and moderate PPI 43 , 44 .…”

Section: Study Recordsmentioning

confidence: 99%

Evaluation of benefits and harms of surgical treatments for post-radical prostatectomy urinary incontinence: a systematic review and meta-analysis protocol

et al. 2019

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Background: Post-radical prostatectomy urinary incontinence (PPI) is a frequent and feared complication that can affect approximately 25% of patients. Between 1 and 10% of patients suffering from PPI will require surgery. The effectiveness of the available surgical interventions has only been compared in a few randomized controlled trials and the available reviews have important limitations regarding both benefits and harms that make them insufficient to inform decision-making. The aim of the study is to provide systematic summaries of benefits and harms of contemporary surgical treatment options for PPI through systematic review and meta-analysis using GRADE methodology and reporting in accord with the PRISMA-P statement. Methods: Studies pertaining to bulking agents, male synthetic slings, compressive balloon systems (ProACT) or artificial urinary sphincters (AUS) used for the treatment of patients suffering from PPI will be included. A systematic search will be conducted using the OVID and PubMED platforms in MEDLINE, Embase and Cochrane databases, and reference lists of relevant reviews and guidelines. Trained independent reviewers will conduct study selection and data extraction. Outcomes will include the number of pads used per day, the 24-h pad weight test, the Patient Global Impression of Improvement (PGI-I) and the Incontinence Quality of Life (IQOL) as possible benefits and the reoperations, the Clavien-Dindo complications and the other reported adverse events as the harms. When possible, pooled analyses will be completed. Risk of bias will be assessed using the CLARITY tools and a new tool for the before-and-after studies without a control group. Finally, study heterogeneity will be assessed, publication bias will be evaluated with funnel plots and quality of evidence rated for each outcome. Discussion: Our study will address patient-important outcomes and will be useful in clinical decision-making as well as identifying key elements for future research. Study registration: PROSPERO: CRD42018073923 05/12/2018

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Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence

Cited by 18 publications

References 35 publications

Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy

Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy

The effectiveness of adjustable trans‐obturator male system (ATOMS) in radiated patients is reduced: A propensity score‐matched analysis

Evaluation of benefits and harms of surgical treatments for post-radical prostatectomy urinary incontinence: a systematic review and meta-analysis protocol

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