Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary Sphincter

No AccessJournal of UrologyAdult Urology1 May 2023Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary SphincterThis article is commented on by the following:Editorial CommentEditorial CommentEditorial Comment Kevin Krughoff and Andrew C. Peterson Kevin KrughoffKevin Krughoff *Correspondence: Oregon Urology Institute, 2400 Hartman Ln, Springfield, OR 97477 telephone: 541-334-3350; E-mail Address: [email protected] https://orcid.org/0000-0002-7957-831X Oregon Urology Institute, Springfield, Oregon More articles by this author and Andrew C. PetersonAndrew C. Peterson https://orcid.org/0000-0002-2265-7797 Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003194AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: For male cancer survivors, the combination of stress urinary incontinence and recurrent bladder neck contracture presents a management dilemma with poor consensus. Our objective was to assess the impact of artificial urinary sphincter placement on bladder neck contracture recurrence among prostate cancer survivors with stress urinary incontinence and bladder neck contracture. Materials and Methods: Men electing artificial urinary sphincter placement at our institution undergo synchronous bladder neck contracture treatment if indicated. An institutional database was queried for men with stress urinary incontinence and ≥1 intervention for bladder neck contracture. Records were divided according to whether an artificial urinary sphincter was ever placed. The impact of artificial urinary sphincter placement on bladder neck contracture recurrence was assessed using a multivariable conditional survival analysis, with survival defined as the recurrence-free interval following bladder neck contracture intervention. The proportional hazards assumption was assessed on the basis of Schoenfeld residuals. Results: The analytic cohort consisted of 118 in the artificial urinary sphincter group and 88 in the non-artificial urinary sphincter group. Patients in both groups underwent a median of 2 (range 1-8) bladder neck contracture interventions over the entire course of their care, encompassing 445 total bladder neck contracture interventions. The artificial urinary sphincter group was on average 2.6 years younger (P = .02) and had a higher pack-year smoking history (P < .01). The presence of an artificial urinary sphincter was associated with a 61% lower bladder neck contracture re-intervention rate (HR 0.39, P < .01, CI 0.30-0.50) at any time when accounting for number of prior bladder neck contracture interventions and bladder neck contracture risk factors. Conclusions: Artificial urinary sphincter placement is associated with a lower rate of bladder neck contracture re-intervention. Artificial urinary sphincter placement should not be delayed or avoided due to the presence of bladder neck contracture. REFERENCES 1. . Improving outcomes of bulbomembranous urethroplasty for radiation-induced urethral strictures in post-UroLume era. Urology. 2017; 99:240. Crossref, Medline, Google Scholar 2. . Glenn's Urologic Surgery. Wolters-Kluwer; 2004. Google Scholar 3. . Incontinence after prostate treatment: AUA/SUFU guideline. 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Link, Google Scholar Support: None Conflict of Interest: K.K.: Boston Scientific; A.P.: Boston Scientific. Ethics Statement: This study received Institutional Review Board approval (IRB No. 00108125). Author Contributions: Design and implantation of the research, data acquisition, analysis of data, drafting the work, revising the work for important intellectual content: K.K.; final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: K.K., A.P.; Conception of the work, revising of the work critically and for important intellectual content: A.P. Data Availability: The data sets generated during and/or analyzed during the current study are not publicly available as data are from an institutional database of patients providing routinely collected data but are available from the corresponding author on reasonable request. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byZhao L, Alford A and Zhang T (2023) Editorial CommentJournal of Urology, VOL. 209, NO. 5, (990-991), Online publication date: 1-May-2023.Peyronnet B and Freton L (2023) Editorial CommentJournal of Urology, VOL. 209, NO. 5, (989-990), Online publication date: 1-May-2023.Chartier-Kastler E (2023) Editorial CommentJournal of Urology, VOL. 209, NO. 5, (989-989), Online publication date: 1-May-2023.Related articlesJournal of Urology23 Feb 2023Editorial CommentJournal of Urology23 Feb 2023Editorial CommentJournal of Urology23 Feb 2023Editorial Comment Volume 209Issue 5May 2023Page: 981-991Supplementary Materials Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsurinary bladder neck obstructionurinary sphincter, artificialurinary incontinenceMetricsAuthor Information Kevin Krughoff Oregon Urology Institute, Springfield, Oregon *Correspondence: Oregon Urology Institute, 2400 Hartman Ln, Springfield, OR 97477 telephone: 541-334-3350; E-mail Address: [email protected] More articles by this author Andrew C. Peterson Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina More articles by this author Expand All Support: None Conflict of Interest: K.K.: Boston Scientific; A.P.: Boston Scientific. Ethics Statement: This study received Institutional Review Board approval (IRB No. 00108125). Author Contributions: Design and implantation of the research, data acquisition, analysis of data, drafting the work, revising the work for important intellectual content: K.K.; final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: K.K., A.P.; Conception of the work, revising of the work critically and for important intellectual content: A.P. Data Availability: The data sets generated during and/or analyzed during the current study are not publicly available as data are from an institutional database of patients providing routinely collected data but are available from the corresponding author on reasonable request. Advertisement PDF downloadLoading ...