Comparing the lifespan of virgin artificial urinary sphincters in radiated patients: transcorporal vs. standard placement.

Abstract

To compare the lifespan of first transcorporal cuff(TC) placement of an artificial urinary sphincter (AUS) versus standard placement(SP) in patients with prior radiotherapy (RT) for prostate cancer(PCa). We reviewed first (virgin) AUS placements from two high-volume care centers between 1/2011 and 1/2021, including PCa patients with RT history. AUS lifespan was assessed via the hazard ratio of device explantation and/or revision within a ten-year timeframe for the TC vs. SP approaches. Chi-square, Fisher's exact, and t-tests compared clinicodemographic variables. Kaplan-Meier curve compared TC and SP lifespan. 85/314 men with AUS met inclusion criteria, with 38.8%(33/85) in the TC group and 61.2%(52/85) in the SP group. Median ages were 69.8(IQR = 65.2-73.6) and 67.1(61.6-72.9), respectively, p = 0.17. Over a median follow up of 51.9 (15.8-86.1) and 80.4(28.1-128.3) months for the TC and SP, overall, 12(36.4%) TC devices were removed (four[12.1%] due to mechanical failures; eight[24.2%] erosions, and two[6.1%] infections) vs. 29(55.8%) in the SP group (14[26.9%] mechanical failures; 11[21.1%] erosions, and five[9.6%] infections). No statistically significant differences were observed between the two approaches, with HR = 0.717, 95% CI 0.37-1.44, p = 0.35. The calculated device survival probabilities for the TC vs. SP at one, five, and 10 years were 78.8% vs. 76.9%, 69.3% vs. 58.7%, and 62.1% vs. 46.7%, respectively. TC cuff insertion for the first AUS implantation in pre-radiated patients showed to be comparable to SP when it comes to device survival, with comparable complication rates. Current guidance for approach selection is primarily based on patient selection and surgeon preference.