Overactive bladder and urgency urinary incontinence in men undergoing artificial urinary sphincter placement

Area of Science:

• Urology
• Medical Devices
• Oncology

Background:

• Overactive bladder (OAB) and urgency urinary incontinence (UUI) are common challenges following prostate cancer treatment.
• Artificial urinary sphincter (AUS) placement is a surgical option for managing post-prostatectomy incontinence.

Purpose of the Study:

• To evaluate persistent and de novo OAB and UUI rates after AUS implantation.
• To compare outcomes between patients who received prior radiation therapy versus those who underwent surgical intervention only.

Main Methods:

• Retrospective review of 79 patients undergoing primary AUS placement and activation.
• Exclusion of patients with neurogenic bladder or insufficient follow-up.
• Primary outcome measures included persistent OAB, persistent UUI, and pad usage pre- and post-AUS activation.

Main Results:

• Resolution of urgency incontinence was significantly lower in radiated patients (31%) compared to non-radiated patients (67%).
• Resolution of OAB symptoms, specifically urinary urgency, was more frequent in non-radiated patients (53%) versus radiated patients (22%).
• Prior radiation was a significant risk factor for OAB post-AUS implantation (OR, 3.63; P=.010), with higher rates of postoperative OAB pharmacotherapy in radiated patients.

Conclusions:

• Radiation therapy is a risk factor for persistent OAB and UUI after AUS activation.
• Pre- and postoperative counseling is crucial for managing patient expectations and addressing OAB symptoms in radiated patients.
• Patients with mixed urinary incontinence or OAB symptoms should not be excluded from AUS consideration.