Radiation therapy after rather than before artificial urinary sphincter (AUS) placement in men who have undergone radical prostatectomy is associated with higher rates of urethral atrophy with recurrent urinary incontinence, according to study findings presented at ICS 2020, a virtual conference sponsored by the International Continence Society.
It also is associated with an increased rate of revision of atrophy and shorter time to device revision for atrophy.
“Our study suggests that if radiation is anticipated, urologists should consider waiting until radiation is complete prior to AUS insertion,” Alexandra Berger, MD, of Brigham and Women’s Hospital in Boston, Massachusetts, told attendees in a concluding statement.
The study included 177 men who underwent RP, AUS, and prostate radiation. Of these, 158 (89.3%) underwent radiation therapy at a median 45 months prior to AUS insertion and 19 (10.7%) underwent radiation therapy at a median 18.0 months after AUS insertion. The median follow-up duration following radiation exposure was 35 months, with no difference between the groups.
Compared with the group receiving radiation before AUS, the post-AUS radiation group had a significantly higher proportion of men who experienced atrophy (52.6% vs 10.1%), and they experienced atrophy earlier (median 12.0 vs 35.5 months), Dr Berger reported.
In addition, the post-AUS radiation group had a significantly shorter time to device revision for atrophy (median 45.5 vs 57.0 months). The groups showed no difference in urologic complications, erosion, explant, or revision.
Radiation after AUS insertion was associated with 8.2-fold increased odds of recurrent incontinence due to atrophy and 3.6-fold increased odds of revision for atrophy, according to Dr Berger.
Berger A, Szymaniak J, Kathrins M. Post-artificial urinary sphincter prostate radiation is a predictor of urethral atrophy with recurrent incontinence. Presented at: ICS 2020, November 19-22. Abstract 4.