title: Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases.
abstract: OBJECTIVE
  Although long-term outcomes after initial placement of artificial urinary sphincters are established, limited data exist comparing sphincter survival in patients with compromised urethras (prior radiation, artificial urinary sphincter placement or urethroplasty). We evaluated artificial urinary sphincter failure in patients with compromised and noncompromised urethras.
  
  
  METHODS
  We performed a retrospective analysis of 86 sphincters placed at a single institution between December 1997 and September 2012. We assessed patient demographic, comorbid disease and surgical characteristics. All nonfunctioning, eroded or infected devices were considered failures.
  
  
  RESULTS
  Of the 86 patients reviewed 67 (78%) had compromised urethras and had higher failure rates than the noncompromised group (34% vs 21%, p=0.02). Compared to the noncompromised group, cases of prior radiation therapy (HR 4.78; 95% CI 1.27, 18.04), urethroplasty (HR 8.61; 95% CI 1.27, 58.51) and previous artificial urinary sphincter placement (HR 8.14; 95% CI 1.71, 38.82) had a significantly increased risk of failure. The risk of artificial urinary sphincter failure increased with more prior procedures. An increased risk of failure was observed after 3.5 cm cuff placement (HR 8.62; 95% CI 2.82, 26.36) but not transcorporal placement (HR 1.21; 95% CI 0.49, 2.99).
  
  
  CONCLUSIONS
  Artificial urinary sphincter placement in patients with compromised urethras from prior artificial urinary sphincter placement, radiation or urethroplasty had a statistically significant higher risk of failure than placement in patients with noncompromised urethras. Urethral mobilization and transection performed during posterior urethroplasty surgeries likely compromise urethral blood supply, predisposing patients to failure. Patients with severely compromised urethras from multiple prior procedures may have improved outcomes with transcorporal cuff placement rather than a 3.5 cm cuff.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California; Urologic Specialists of Oklahoma, Tulsa, Oklahoma.
authors.forename: James B
authors.initials: JB
authors.lastname: McGeady
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California.
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Truesdale
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Blaschko
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California.
authors.forename: Stacey
authors.initials: S
authors.lastname: Kenfield
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California. Electronic address: bbreyer@urology.ucsf.edu.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
mesh_terms: D000368:Aged; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014521:Urethra / Q000528:radiation effects* / Q000601:surgery*; D016741:Urinary Sphincter, Artificial
keywords: artificial; radiation; urinary incontinence; urinary sphincter