World Journal of Urology

, Volume 37, Issue 12, pp 2755–2761 | Cite as

Artificial urinary sphincter longevity following transurethral resection of the prostate in the setting of prostate cancer

  • Andrew J. CohenEmail author
  • William Boysen
  • Kristine Kuchta
  • Sarah Faris
  • Jaclyn Milose
Original Article



Refractory urinary incontinence after channel transurethral resection of the prostate (cTURP) (TURP in the setting of prostate cancer) is a rare occurrence treated with artificial urinary sphincter (AUS). We sought to characterize those patients receiving AUS after cTURP and understand device longevity.

Materials and methods

We identified patients who underwent cTURP and AUS placement in SEER-Medicare from 2002 to 2014. We analyzed factors affecting device longevity using multivariable Cox proportional hazard models. We performed propensity matching to accurately compare patients receiving AUS after cTURP to those receiving AUS after radical prostatectomy (RP).


For patients undergoing cTURP, 201 out of 56,957 ultimately underwent AUS placement (< 0.5%). AUS after cTURP incurred a 48.4% rate of reoperation versus 30.9% after RP. Importantly, patients undergoing cTURP were significantly older than those undergoing RP [75 vs. 71 years of age (p < 0.01)]. At 3 years after insertion, 28.2% of patients after RP required reoperation compared to 37.8% of patients post-cTURP (p < 0.01). There were no detectable differences in revision rates for those patients who underwent traditional vs. laser cTURP. Patients with a history of radiation therapy had significantly shorter device survival. Even after propensity matching, patients receiving AUS after cTURP incurred more short-term complications compared to AUS after RP. Differences in device longevity were diminished after propensity match.


In the SEER-Medicare population, AUS after cTURP remains rare. While there is an increased risk of infectious complications, AUS after cTURP fared similarly to AUS after RP in terms of device longevity. A history of radiation therapy leads to worse outcome for all patients.


Transurethral resection of prostate Artificial urinary sphincter Complications Radiation Explantation Thermotherapy 


Author contributions

JM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. JM, AC and SF: protocol/project development. KK: data collection or management. KK, AC, JM and WB: data analysis. All authors were involved in drafting and critical revision of the manuscript. KK and others: statistical analysis.

Compliance with ethical standards

Conflict of interest

All authors have no disclosure of potential conflicts of interest.

Ethical statements

This research was given IRB exemption and received additional SEER-Medicare exemption, as anonymous data were used.

Supplementary material

345_2019_2684_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)
345_2019_2684_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 17 kb)


  1. 1.
    Gratzke C et al (2015) EAU Guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 67(6):1099–1109CrossRefGoogle Scholar
  2. 2.
    Ficarra V et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417CrossRefGoogle Scholar
  3. 3.
    Theodorou C, Moutzouris G, Floratos D, Plastiras D, Katsifotis C, Mertziotis N (1998) Incontinence after surgery for benign prostatic hypertrophy: the case for complex approach and treatment. Eur Urol 33(4):370–375CrossRefGoogle Scholar
  4. 4.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50(5):969–980CrossRefGoogle Scholar
  5. 5.
    Pickard R (2007) Male incontinence: pathophysiology and management. Indian J Urol IJU 23(2):179–180CrossRefGoogle Scholar
  6. 6.
    Mazur AW, Thompson IM (1991) Efficacy and morbidity of ‘channel’ TURP. Urology 38(6):526–528CrossRefGoogle Scholar
  7. 7.
    Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A (2017) Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71(6):936–944CrossRefGoogle Scholar
  8. 8.
    Friedl A et al (2017) The adjustable transobturator male system in stress urinary incontinence after transurethral resection of the prostate. Urology 109:184–189CrossRefGoogle Scholar
  9. 9.
    Kretschmer A et al (2016) Long-term outcome of the retrourethral transobturator male sling after transurethral resection of the prostate. Int Neurourol J 20(4):335–341CrossRefGoogle Scholar
  10. 10.
    Hogewoning CRC, Meij LAM, Pelger RCM, Putter H, Krouwel EM, Elzevier HW (2017) Sling surgery for the treatment of urinary incontinence after transurethral resection of the prostate: new data on the virtue male sling and an evaluation of literature. Urology 100:187–192CrossRefGoogle Scholar
  11. 11.
    Yafi FA, Powers MK, Zurawin J, Hellstrom WJG (2016) Contemporary review of artificial urinary sphincters for male stress urinary incontinence. Sex Med Rev 4(2):157–166CrossRefGoogle Scholar
  12. 12.
    Gundian JC, Barrett DM, Parulkar BG (1993) Mayo Clinic experience with the AS800 artificial urinary sphincter for urinary incontinence after transurethral resection of prostate or open prostatectomy. Urology 41(4):318–321CrossRefGoogle Scholar
  13. 13.
    Cohen AJ, Kuchta K, Park S, Milose J (2018) Patterns and timing of artificial urinary sphincter failure. World J Urol 36:939–945CrossRefGoogle Scholar
  14. 14.
    Klabunde CN, Potosky AL, Legler JM, Warren JL (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53(12):1258–1267CrossRefGoogle Scholar
  15. 15.
    Kuntz RM, Ahyai S, Lehrich K, Fayad A (2004) Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol 172(3):1012–1016CrossRefGoogle Scholar
  16. 16.
    Bachmann A et al (2015) A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the goliath study. J Urol 193(2):570–578CrossRefGoogle Scholar
  17. 17.
    Bruschini H, Simonetti R, Antunes AA, Srougi M (2011) Urinary incontinence following surgery for BPH: the role of aging on the incidence of bladder dysfunction. Int Braz J Urol 37(3):380–386 (discussion 387) CrossRefGoogle Scholar
  18. 18.
    Punnen S, Cowan JE, Chan JM, Carroll PR, Cooperberg MR (2015) Long-term health-related quality of life after primary treatment for localized prostate cancer: results from the CaPSURE registry. Eur Urol 68(4):600–608CrossRefGoogle Scholar
  19. 19.
    Kopp RP et al (2013) The burden of urinary incontinence and urinary bother among elderly prostate cancer survivors. Eur Urol 64(4):672–679CrossRefGoogle Scholar
  20. 20.
    Viers BR, Linder BJ, Rivera ME, Rangel LJ, Ziegelmann MJ, Elliott DS (2016) Long-term quality of life and functional outcomes among primary and secondary artificial urinary sphincter implantations in men with stress urinary incontinence. J Urol 196(3):838–843CrossRefGoogle Scholar
  21. 21.
    Polland A et al (2017) Preoperative symptoms predict continence after post-radiation transurethral resection of prostate. Can J Urol 24(4):8903–8909PubMedGoogle Scholar
  22. 22.
    Viers BR et al (2016) The impact of diabetes mellitus and obesity on artificial urinary sphincter outcomes in men. Urology 98:176–182CrossRefGoogle Scholar
  23. 23.
    Kaufman MR et al (2017) Prior radiation therapy decreases time to idiopathic erosion of artificial urinary sphincter: a multi-institutional analysis. J Urol 199:1037–1041CrossRefGoogle Scholar
  24. 24.
    Zlotta AR, Giannakopoulos X, Maehlum O, Ostrem T, Schulman CC (2003) Long-term evaluation of transurethral needle ablation of the prostate (TUNA) for treatment of symptomatic benign prostatic hyperplasia: clinical outcome up to 5 years from three centers. Eur Urol 44(1):89–93CrossRefGoogle Scholar
  25. 25.
    Onyeji IC et al (2017) Impact of surgeon case volume on reoperation rates after inflatable penile prosthesis surgery. J Urol 197(1):223–229CrossRefGoogle Scholar
  26. 26.
    Wilson SK, Zumbe J, Henry GD, Salem EA, Delk JR, Cleves MA (2007) Infection reduction using antibiotic-coated inflatable penile prosthesis. Urology 70(2):337–340CrossRefGoogle Scholar
  27. 27.
    Simhan J et al (2015) 3.5 cm artificial urinary sphincter cuff erosion occurs predominantly in irradiated patients. J Urol 193(2):593–597CrossRefGoogle Scholar
  28. 28.
    Suskind AM, Walter LC, Zhao S, Finlayson E (2017) Functional outcomes after transurethral resection of the prostate in nursing home residents. J Am Geriatr Soc 65(4):699–703CrossRefGoogle Scholar
  29. 29.
    Gilling P, Anderson P, Tan A (2017) Aquablation of the prostate for symptomatic benign prostatic hyperplasia: 1-year results. J Urol 197(6):1565–1572CrossRefGoogle Scholar
  30. 30.
    Umari P et al (2017) Robotic assisted simple prostatectomy versus holmium laser enucleation of the prostate for lower urinary tract symptoms in patients with large volume prostate: a comparative analysis from a high volume center. J Urol 197(4):1108–1114CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section of UrologyUniversity of Chicago MedicineChicagoUSA
  2. 2.Division of UrologyNorthShore University HealthSystemEvanstonUSA

Personalised recommendations