Transcorporal artificial urinary sphincter placement for incontinence in high-risk patients after treatment of prostate cancer

OBJECTIVES To investigate the transcorporal (TC) vs standard (ST) approach of artificial urinary sphincter (AUS) placement for incontinence after treatment of prostate adenocarcinoma (PCa) with radiotherapy or surgery, or both. METHODS A database was created to include the data from all patients who had undergone AUS placement from January 2000 to August 2005 at the University of California, San Francisco, Medical Center. We noted the demographic features, comorbidities, PCa therapy, technique for AUS placement, and postoperative outcome. The continence and failure rates were recorded for TC AUS placement in patients previously treated for PCa. RESULTS A total of 30 patients underwent aus surgery during the study period: 26 for incontinence after PCa treatment. Of the 26 patients, 18 had undergone ST (ST group) and 8 had undergone TC (TC group) AUS placement, with a minimal follow-up of 12 months and a mean follow-up of 31 and 28 months, respectively. The 2 groups did not differ widely in age or comorbidities. Of the patients in the ST and TC groups, 44% and 50% had undergone external beam radiotherapy or brachytherapy and 78% and 100% had undergone radical prostatectomy, respectively. Of the patients in the ST and TC groups, 22% and 89% had undergone >= 2 types of urethral surgery before AUS placement, respectively. A total of 50% of TC group underwent TC placement without having undergone a previous sling or ST AUS procedure. The AUS removal rates were equivalent between the 2 groups at 2 years. Finally, the success rate for social continence was 69% and 81% for ST and TC group, respectively. CONCLUSIONS The results of our study, with 2 years of follow-up, have shown that TC AUS placement is an effective salvage or primary incontinence treatment for high-risk patients after PCa therapy.