📃 Paper Title: Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction
🧍 Author: Walsh
🕒 Year: 2002
📚 Journal: British Journal of Urology International
🌎 Country: USA
ㅤContext to the study:
Can you tell me about the safety and efficacy of artifical urinary sphincter implants post prostatectomy?
ㅤ✅ Take-home message of study:
This study assessed safety, efficacy and satisfaction following Artificial urinary sphincter (AUS) implantation for post prostatectomy incontinence in irradiated and unirradiated patients.
Overall, surgical revision was equally common in irradiated (36%) and unirradiated (24%) patients.
After activating the AUS, urethral atrophy, infection and erosion requiring surgical revision were more common in irradiated patients (41% vs. 11%; P < 0.05)
70% of patients reported a significant improvement in continence, regardless of previous irradiation.
Patient satisfaction remained high, with > 80% of patients stating that they would undergo surgery again and/or recommend it to others, despite previous irradiation and/or the need for surgical revision.
ㅤ Prospective observational study
ㅤ
Study participants:
Patient Characteristics
98 Males
Severe urinary incontinence
Radical prostatectomy (n=85) or transurethral prostatectomy (n=13)
22 patients ahd adjuvant ERBT post-operatively; 76 patients - no radiotherapy
Similar comborbidity profile
ㅤ
ㅤ
Key study outcomes:
Mean follow up: 46 (5-118) months
Overall revision rate: 25% Revisions tended to be more frequent in irradiated than in unirradiated patients but the differences were not statistically significant P=0.06)
Irradiated patients more likely to have surgical complications after activation of sphincter; urethral atrophy, infection and erosion (41% in irradiated group vs 11% in unirradiated group, p<0.01).
Irradiated patients more likely to report that incontinence remains unchanged (p=0.02) and less likely to have complete resolution of incontinence (p=0.03).
Similar satisfaction rates between irradiated and unirradiated groups (89% very satisfied in irradiated, 92% in unirradiated, no statistical significance).
ㅤ
ㅤ
Study Limitations:
No minimal sample size to get statistical power calculated
Much smaller sample size of irradiated patients compared to unirradiated
7% lost to follow up
Management of patients post operatively not standardized (commented inappropriate urethral catheterization as cause of complication in irradiated patients with infection and erosion).
ㅤ