What is the fate of artificial urinary sphincters among men undergoing repetitive bladder cancer treatment?
Purpose
Functional characteristics and durability of the artificial urinary sphincter (AUS) among patients who develop bladder cancer has been poorly characterized. We sought to evaluate AUS outcomes among patients subsequently diagnosed with bladder cancer, in order to describe device survivability when subject to diagnostic and therapeutic procedures such as cystoscopy, transurethral resection, and cystectomy.


Materials and Methods
We retrospectively reviewed 1,803 male patients treated with AUS surgery at a single institution between 1983-2014. We describe AUS device outcomes among patients undergoing surveillance and treatment for bladder cancer.


Results
Following AUS placement, 14 (0.8%) patients were subsequently diagnosed with and treated for bladder cancer and 4 patients with bladder cancer undergoing treatment and screening, subsequently received AUS placement. The median follow-up from device placement was 7.2 years (interquartile range [IQR], 2.8-11.5), and the median time from AUS placement to bladder cancer diagnosis was 6 (IQR, 0-9). There were a total of 8 primary and 1 secondary devices failures. Despite a median of 2 diagnostic cystoscopies (IQR, 1-6) and 0 bladder tumor resections (IQR, 0-0) per patient following device implantation, only 1 (5.6%) patient experienced an iatrogenic erosion related to urethral manipulation. Among those undergoing cystectomy (n=4), 1 device was left in situ without complication.


Conclusions
Bladder cancer surveillance and treatment with an AUS device in place appears to confer minimal additional risk to AUS survival. Careful attention should be given to device deactivation and use of the smallest caliber instruments available to minimize the risk of iatrogenic urethral erosion.
['Heiner|S Mitchell|SM|', 'Viers|Boyd R|BR|', 'Rivera|Marcelino E|ME|', 'Linder|Brian J|BJ|', 'Elliott|Daniel S|DS|https://orcid.org/0000-0001-7568-8805']
D000368:Aged D000369:Aged, 80 and over D015653:Cystectomy D003558:Cystoscopy D005500:Follow-Up Studies D006801:Humans D008297:Male D011475:Prosthesis Failure D012189:Retrospective Studies D001749:Urinary Bladder Neoplasms D014549:Urinary Incontinence D016741:Urinary Sphincter, Artificial
Cystoscopy Urinary bladder neoplasms Urinary incontinence Urinary sphincter, artificial