The impact of prior external beam radiation therapy on device outcomes following artificial urinary sphincter revision surgery.

Autor:	Manka MG; Department of Urology, Mayo Clinic, Rochester, MN, USA., Linder BJ; Department of Urology, Mayo Clinic, Rochester, MN, USA.; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA., Rangel LJ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA., Elliott DS; Department of Urology, Mayo Clinic, Rochester, MN, USA.
Jazyk:	angličtina
Zdroj:	Translational andrology and urology [Transl Androl Urol] 2020 Feb; Vol. 9 (1), pp. 67-72.
DOI:	10.21037/tau.2019.09.09
Abstrakt:	Background: Previous reports on the effect of radiation therapy on primary artificial urinary sphincter (AUS) device survival have met with conflicting results, and data evaluating this after revision surgery is sparse. Thus, we evaluated AUS device outcomes after revision surgery, and compared them among individuals who did versus did not undergo prior radiation therapy. Methods: A database of patients who underwent AUS revision surgery at our institution was used to perform a retrospective review. Device survival endpoints, including overall survival, infection/erosion, urethral atrophy, and device malfunction were evaluated. Overall device survival (i.e., any repeat surgery) was compared between groups, stratified by external beam radiation status, via Kaplan-Meier method. Proportional hazard regression and competing risk analysis were used to evaluate association between prior radiation therapy and device outcomes. Results: From 1983 to 2016, a total of 527 patients underwent AUS revision surgery. Of these, 173 (33%) patients had undergone prior radiation therapy. Patients with prior radiation therapy were more likely to have diabetes mellitus (22% vs . 14%; P=0.05), hypertension (71% vs . 56%; P<0.01), previous vesicourethral anastomotic stenosis (41% vs . 19%; P<0.0001), as well as prior androgen deprivation therapy (26% vs . 6%; P<0.0001). Overall, there was not enough evidence to support the existence of a significant difference in device survival among patients with or without a history of radiotherapy, with 1- and 5-year-overall survival of 84% vs . 85% and 51% vs . 64%, respectively (P=0.07). On competing risk analysis, a history of pelvic radiation therapy was not enough evidence to support a significant association with the risk of device infection/erosion, mechanical failure, or urethral atrophy. Conclusions: There was not enough evidence of a difference in the rate of device erosion or infection, cuff atrophy, malfunction, or overall device survival following AUS revision surgery between patients with and without a history of pelvic radiation. These findings may be helpful when counseling patients regarding outcomes after AUS revision. Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare. (2020 Translational Andrology and Urology. All rights reserved.)
Databáze:	MEDLINE
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