Abstract：
OBJECTIVE: To compare the lifespan of first transcorporal cuff (TC) placement of an artificial urinary sphincter (AUS) versus standard placement (SP) in patients with prior radiotherapy (RT) for prostate cancer (PCa).
METHODS: We reviewed first (virgin) AUS placements from two high-volume care centers between 1/2011 and 1/2021, including PCa patients with RT history. AUS lifespan was assessed via the hazard ratio of device explantation and/or revision within a ten-year timeframe for the TC vs. SP approaches. Chi-square, Fisher\'s exact, and t-tests compared clinicodemographic variables. Kaplan-Meier curve compared TC and SP lifespan.
RESULTS: 85/314 men with AUS met inclusion criteria, with 38.8% (33/85) in the TC group and 61.2% (52/85) in the SP group. Median ages were 69.8 (IQR = 65.2-73.6) and 67.1 (61.6-72.9), respectively, p = 0.17. Over a median follow up of 51.9 (15.8-86.1) and 80.4 (28.1-128.3) months for the TC and SP, overall, 12 (36.4%) TC devices were removed (four [12.1%] due to mechanical failures; eight [24.2%] erosions, and two [6.1%] infections) vs. 29 (55.8%) in the SP group (14 [26.9%] mechanical failures; 11 [21.1%] erosions, and five [9.6%] infections). No statistically significant differences were observed between the two approaches, with HR = 0.717, 95% CI 0.37-1.44, p = 0.35. The calculated device survival probabilities for the TC vs. SP at one, five, and 10 years were 78.8% vs. 76.9%, 69.3% vs. 58.7%, and 62.1% vs. 46.7%, respectively.
CONCLUSIONS: TC cuff insertion for the first AUS implantation in pre-radiated patients showed to be comparable to SP when it comes to device survival, with comparable complication rates. Current guidance for approach selection is primarily based on patient selection and surgeon preference.
METHODS: We reviewed first (virgin) AUS placements from two high-volume care centers between 1/2011 and 1/2021, including PCa patients with RT history. AUS lifespan was assessed via the hazard ratio of device explantation and/or revision within a ten-year timeframe for the TC vs. SP approaches. Chi-square, Fisher\'s exact, and t-tests compared clinicodemographic variables. Kaplan-Meier curve compared TC and SP lifespan.
RESULTS: 85/314 men with AUS met inclusion criteria, with 38.8% (33/85) in the TC group and 61.2% (52/85) in the SP group. Median ages were 69.8 (IQR = 65.2-73.6) and 67.1 (61.6-72.9), respectively, p = 0.17. Over a median follow up of 51.9 (15.8-86.1) and 80.4 (28.1-128.3) months for the TC and SP, overall, 12 (36.4%) TC devices were removed (four [12.1%] due to mechanical failures; eight [24.2%] erosions, and two [6.1%] infections) vs. 29 (55.8%) in the SP group (14 [26.9%] mechanical failures; 11 [21.1%] erosions, and five [9.6%] infections). No statistically significant differences were observed between the two approaches, with HR = 0.717, 95% CI 0.37-1.44, p = 0.35. The calculated device survival probabilities for the TC vs. SP at one, five, and 10 years were 78.8% vs. 76.9%, 69.3% vs. 58.7%, and 62.1% vs. 46.7%, respectively.
CONCLUSIONS: TC cuff insertion for the first AUS implantation in pre-radiated patients showed to be comparable to SP when it comes to device survival, with comparable complication rates. Current guidance for approach selection is primarily based on patient selection and surgeon preference.
摘要：
目的：比较在前列腺癌（PCa）放疗（RT）的患者中，人工尿道括约肌（AUS）的首次体囊（TC）放置与标准放置（SP）的寿命。
方法：我们回顾了2011年1月至2021年1月1日来自两个高容量护理中心的首次（处女）AUS安置，包括有RT病史的PCa患者。AUS寿命是通过TC与TC在十年时间范围内的设备外植体和/或翻修的危险比来评估的。SP方法。卡方，费希尔的精确,和t检验比较了临床人口统计学变量。Kaplan-Meier曲线比较了TC和SP寿命。
结果：85/314男性AUS符合纳入标准，TC组为38.8%(33/85),SP组为61.2%(52/85)。中位年龄为69.8（IQR=65.2-73.6）和67.1（61.6-72.9），分别,p=0.17。TC和SP的中位随访时间为51.9（15.8-86.1）和80.4（28.1-128.3）个月，总的来说,12（36.4％）TC设备被移除（由于机械故障，四个[12.1％]；八个[24.2％]侵蚀，和两个[6.1%]感染)与SP组29例（55.8％）（14[26.9％]机械故障；11[21.1％]侵蚀，和五次[9.6%]感染)。两种方法之间没有观察到统计学上的显着差异，HR=0.717，95%CI0.37-1.44，p=0.35。TC与TC的计算设备生存概率SP在一个，五,10年是78.8%，而不是76.9%,69.3%与58.7%,和62.1%vs.46.7%,分别。
结论：在预照射患者中进行首次AUS植入的TC袖带插入在装置存活方面与SP相当。并发症发生率相当。当前的方法选择指南主要基于患者选择和外科医生偏好。
方法：我们回顾了2011年1月至2021年1月1日来自两个高容量护理中心的首次（处女）AUS安置，包括有RT病史的PCa患者。AUS寿命是通过TC与TC在十年时间范围内的设备外植体和/或翻修的危险比来评估的。SP方法。卡方，费希尔的精确,和t检验比较了临床人口统计学变量。Kaplan-Meier曲线比较了TC和SP寿命。
结果：85/314男性AUS符合纳入标准，TC组为38.8%(33/85),SP组为61.2%(52/85)。中位年龄为69.8（IQR=65.2-73.6）和67.1（61.6-72.9），分别,p=0.17。TC和SP的中位随访时间为51.9（15.8-86.1）和80.4（28.1-128.3）个月，总的来说,12（36.4％）TC设备被移除（由于机械故障，四个[12.1％]；八个[24.2％]侵蚀，和两个[6.1%]感染)与SP组29例（55.8％）（14[26.9％]机械故障；11[21.1％]侵蚀，和五次[9.6%]感染)。两种方法之间没有观察到统计学上的显着差异，HR=0.717，95%CI0.37-1.44，p=0.35。TC与TC的计算设备生存概率SP在一个，五,10年是78.8%，而不是76.9%,69.3%与58.7%,和62.1%vs.46.7%,分别。
结论：在预照射患者中进行首次AUS植入的TC袖带插入在装置存活方面与SP相当。并发症发生率相当。当前的方法选择指南主要基于患者选择和外科医生偏好。
