Timing Considerations for Artificial Urinary Sphincter Implantation Post-Pelvic Radiotherapy

Background To explore the optimal timing for placing an artificial urinary sphincter (AUS) post-radiation therapy (RT). Methods A bi-institutional retrospective review of all patients who underwent their first (virgin) AUS placement after pelvic RT between January 1st 2011 and July 1st 2023. To determine the optimal timeline for device implantation 2-5 years post-RT, we compared hazard ratios (HRs) for device revision/explantation (Rev/Exp) using Kaplan-Meier curves for each year (earlier vs. later than 2/3/4/5 years post-RT).The Pearson correlation coefficient identified trends in Rev/Exp reasons (erosion/infection vs. other). Results Seventy-two patients met our inclusion criteria with a median age of 65.5 years (IQR 70-81.25). Fifteen (20.1%) had undergone one or more previous urethral or bladder neck interventions (urethroplasty in one [1.4%], internal urethrotomy in 7 [9.7%], and bladder neck incision in 9 [12.5%]). After a median follow-up of 57.5 months (IQR 13-107), a total of 36 (50%) devices were Rev/Exp, with mechanical failure in 14 (19.4%) and device erosion in 12 (16.7%) being the main reasons. Device survival analysis revealed no significant difference in the risk of device Rev/Exp when implanted earlier versus later than 2, 3, 4,or 5 years post-RT, with p-values of 0.3, 0.3, 0.4, and 0.4, respectively. A constant trend towards higher infection/erosion rates as indication for device Rev/Exp the later the insertion was noticed:R2 = 0.98. Conclusions Despite a small sample size, our study indicates that implanting an AUS within 5-years after RT shows comparable device lifespan. However, later insertions may have higher removal rates due to erosion/infection. Clinical trial registration Not applicable