title: Radiation history affects continence outcomes after advance transobturator sling placement in patients with post-prostatectomy incontinence.
abstract: OBJECTIVE
  To evaluate the effects of preoperative external radiation therapy (XRT) on a cohort of patients who underwent AdVance transobturator urethral sling (ATUS) placement for post-prostatectomy incontinence.
  
  
  METHODS
  Thirty-seven patients underwent placement of an ATUS from 2008 to 2010. Patients with and without a history of preoperative XRT were retrospectively compared in regard to their demographical, preoperative, perioperative, and postoperative details.
  
  
  RESULTS
  The median follow-up was 17.3 months. Preoperative pad usage was significantly higher in the XRT patient group (P = .03). Overall, 19 patients (51.4%) used no pads, 10 patients (27.0%) were improved, 4 patients (10.8%) had no change, and 4 patients (10.8%) experienced worsening incontinence after the surgery. In patients with and without a history of XRT, 0 (0%) and 19 (63.3%) used no pads, 2 (28.6%) and 8 (26.7%) were improved, 2 (28.6%) and 2 (6.7%) showed no change, and 3 (42.9%) and 1 (3.3%) were worse, respectively. In comparing patients with more severe incontinence preoperatively (>1 pad/day), those with and without radiation, 0 (0%) and 7 (46.7%) used no pads, 2 (28.6%) and 7 (46.7%) were improved, 2 (28.6%) and 0 (0%) had no change, and 3 (42.9%) and 1 (6.7%) were worse, respectively, after ATUS placement. Thus, patients without XRT had an advantage in postoperative pad usage (P = .001), and, furthermore, had improved quality of life (86.2% vs 28.6%, P = .006).
  
  
  CONCLUSIONS
  The ATUS provides excellent continence outcomes in patients suffering from post-prostatectomy urinary incontinence. However, previous pelvic irradiation seems to severely compromise the effectiveness of the ATUS.
authors.affiliation: Department of Urologic Oncology, City of Hope Cancer Center, Duarte, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Torrey
authors.forename: Nitya
authors.initials: N
authors.lastname: Rajeshuni
authors.forename: Nora
authors.initials: N
authors.lastname: Ruel
authors.forename: Shantel
authors.initials: S
authors.lastname: Muldrew
authors.forename: Kevin
authors.initials: K
authors.lastname: Chan
mesh_terms: D041342:Absorbent Pads; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D014563:Urodynamics