Cohen AJ, et al. - The authors aimed at ascertaining population-based trends in artificial urinary sphincter (AUS) placement after prostatectomy and determining the effect of timing on device survival and complications. In the Medicare population, late AUS implantation was associated with prolonged device survival initially, while radiation and prior sling surgery predicted for earlier reoperation. Less immediate complications were evident among patients with delayed AUS implantation.

Methods

• From 2002 to 2011, patients who underwent prostatectomy and AUS placement were identified in SEER-Medicare.
• Factors affecting the time of reoperation from AUS implantation and prostatectomy were analyzed using multivariable Cox proportional hazard models.

Results

• AUS placement was performed in 841 men at a median 23 months after prostatectomy.
• Higher clinical stage, more frequent open prostatectomy, or prior sling placement (p < 0.03) were observed among patients who underwent reoperation (28.5%).
• No differences in rates of diabetes, smoking status, prior radiation therapy, or Charlson Comorbidity Index were evident between those requiring reoperation vs not (all p > 0.15).
• Less necessity for operative reinterventions was observed among patients with AUS placement > 15 months after prostatectomy (75%) initially.
• Patients with later AUS placement were significantly more frequently received radiation therapy [22.9 vs. 3.8% (p < 0.01)].
• However, multivariate analysis confirmed that late implantation was protective during the first 5 years after AUS placement [HR 0.79 (95% CI 0.67–0.92); p<0.01].
• History of radiation [HR 1.93 (95% CI 1.33–2.80); p < 0.01] and history of prior sling [HR 1.70 (95% CI 1.08–2.68); p=0.02] were the included factors independently associated with a shorter interval time until reoperation.
• Delayed AUS implantation reduced reoperative risk even for patients who underwent radiation therapy.