Artificial Urinary Sphincter Reverses Weight Gain Associated with Post-Prostatectomy Incontinence

Abstract

ABSTRACT Introduction Post-prostatectomy stress urinary incontinence (PPI) is associated with decreased physical activity, a known risk factor for weight gain and negative health outcomes. The relationships of PPI severity and its surgical correction to body mass index (BMI) are unknown. Objective We sought to examine the association between urinary incontinence severity and BMI changes before and after artificial urinary sphincter (AUS) insertion. Methods We performed a single-institution, retrospective review of 1513 AUS and inflatable penile prosthesis (IPP) insertion cases performed between 2008 and 2020. Inclusion criteria included a history of radical prostatectomy (RP) and complete data on PPI and BMI. The IPP cohort served as a surgical control. PPI severity was assessed by pads per day (PPD). BMI data were reviewed at the following three time points: (a) at RP, (b) at urologic prosthetic surgery (UPS), and (c) 12 months post-UPS. Multivariable linear regression assessed the associations between (a) PPI severity and BMI change from RP to UPS and (b) AUS insertion and BMI change 12 months post-UPS. Results We identified 250 men (187 AUS and 63 IPP) who met selection criteria. Men in the AUS group had a mean BMI increase between RP and UPS of + 1.0 kg/m2 versus - 0.6 kg/m2 in the IPP group (p < 0.01, duration 26.0 ± 21.8 months). Higher PPD use was associated with greater BMI gain after RP (Figure 1A, p = 0.03). On multivariable analysis, higher PPD use at the time of UPS was positively associated with BMI gain (Rho coeff. 0.50 kg/m2, p < 0.01), independent of RT and ADT. AUS insertion was independently associated with a decrease in BMI of -2.83 kg/m2 12 months post-UPS (p = 0.02) on multivariable analysis. Magnitude of incontinence improvement after AUS insertion was associated with greater BMI reduction at 12 months (Figure 1B, p = 0.04). Conclusions PPI is associated with weight gain, and its correction via AUS insertion is associated with weight loss. Because severe PPI is a potential risk factor for weight gain and subsequent negative health outcomes, timely anti-incontinence surgery is prudent for prostate cancer survivorship care. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast