Editorial Comment

Abstract

This is a well-presented paper describing a retrospective, nonrandomized, single surgeon series of 158 men with urinary incontinence who underwent placement of an artificial urinary sphincter (AUS) with or without adjuvant radiation therapy after radical prostatectomy for prostate cancer over an 8-year period. The authors examine the clinical risk factors associated with infection, erosion, or mechanical failure in these patients. They outline risk factors of urethral comorbidities as having very high failure when combined with adjuvant radiation therapy. A history of adjuvant radiation, prior male sling placement, or vesicourethral anastomotic stenosis increased the risk of AUS mechanical failure on univariable analysis. Adjuvant radiation therapy and prior male sling placement retained significance on multivariable analysis. On both univariable and multivariable analyses, adjuvant radiation therapy did not significantly predict urethral atrophy or AUS mechanical failure; however, it was a significant predictor of infection or urethral erosion on univariable and multivariable analyses. Many patients present clinically with both infection and erosion at the time of evaluation and device explantation. In patients with urethral comorbidities (vesicourethral anastomotic stenosis, male sling, or urethral stricture), those also treated with adjuvant radiation therapy have the overall worst AUS device survival in this series.