title: Clinical Risk Factors Associated With Urethral Atrophy.
abstract: OBJECTIVE
  To analyze a series of clinical risk factors associated with pretreatment urethral atrophy.
  
  
  METHODS
  We retrospectively reviewed 301 patients who underwent artificial urinary sphincter (AUS) placement between September 2009 and November 2015; of these, 60 (19.9%) transcorporal cuff patients were excluded. Patients were stratified into 2 groups based on intraoperative spongiosal circumference measurements. Men with urethral atrophy (3.5 cm cuff size) were compared to controls (≥4 cm cuff size). Chi-square test, Mann-Whitney U test, and logistic regression analyses were performed to determine risk factors for urethral atrophy.
  
  
  RESULTS
  Among 241 AUS patients analyzed, urethral atrophy was present in 151 patients (62.7%) compared to 90 patients (37.3%) who received larger cuffs (range 4-5.5 cm). Patients with urethral atrophy were older (71.1years vs 68.3 years; P < .02), more likely to have received radiation (52.9% vs. 33.3%; P < .007), and had a longer time interval between prostate cancer treatment and AUS surgery (8.9 years vs. 6.6 years; P < .033). On multivariable analysis, radiation therapy was independently associated with risk of urethral atrophy (odds ratio 1.77, 95% confidence interval: 1.01-3.13; P = .046), whereas greater time between cancer therapy and incontinence surgery approached clinical significance (odds ratio 1.05, 95% confidence interval 1.00-1.09; P = .05).
  
  
  CONCLUSIONS
  History of radiation therapy and increasing length of time from prostate cancer treatment are associated with urethral atrophy before AUS placement.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Boyd R
authors.initials: BR
authors.lastname: Viers
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Shawn
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Hofer
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Dugi
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Pagliara
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Nirmish
authors.initials: N
authors.lastname: Singla
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Jordon
authors.initials: J
authors.lastname: Walker
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Scott
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9110. Electronic address: allen.morey@utsouthwestern.edu.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
mesh_terms: D000368:Aged; D001284:Atrophy / Q000175:diagnosis / Q000209:etiology; D016009:Chi-Square Distribution; D006801:Humans; D016015:Logistic Models; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014521:Urethra / Q000473:pathology*; D014522:Urethral Diseases / Q000175:diagnosis / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*