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

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Abstract

Purpose

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).

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Section of Urology, University of Chicago Medicine, 5841 S. Maryland Avenue, MC6038, Chicago, IL, 60637, USA

    Andrew J. Cohen, William Boysen & Sarah Faris

  2. Division of Urology, NorthShore University HealthSystem, Evanston, USA

    Kristine Kuchta & Jaclyn Milose

Authors
  1. Andrew J. Cohen
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  2. William Boysen
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  3. Kristine Kuchta
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  4. Sarah Faris
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  5. Jaclyn Milose
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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.

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Correspondence to Andrew J. Cohen.

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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.

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Cohen, A.J., Boysen, W., Kuchta, K. et al. Artificial urinary sphincter longevity following transurethral resection of the prostate in the setting of prostate cancer. World J Urol 37, 2755–2761 (2019). https://doi.org/10.1007/s00345-019-02684-z

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  • DOI: https://doi.org/10.1007/s00345-019-02684-z

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