(203) RISK FACTORS FOR REPEAT EROSION IN RADIATED PATIENTS UNDERGOING REIMPLANTATION OF ARTIFICIAL URINARY SPHINCTER DEVICES

Abstract Introduction With limited alternatives to achieve continence, radiated patients with prior artificial urinary sphincter (AUS) erosion represent a challenging population at risk for a subsequent erosion event. Though prior analyses have assessed risk factors for the development of subsequent AUS erosion after an initial erosion event, these investigations are often limited by the inclusion of non-radiated erosion patients in the study design. Objective We analyze a multi-institutional cohort to identify independent predictors of repeat erosion events in a large series of radiated prostate cancer survivors. Methods A multi-institutional, retrospective review was performed of all radiated patients with history of prior AUS erosion. Clinical features, procedural specifics and surgical outcomes were collected for all patients who experienced an erosion event and underwent repeat AUS implantation. Univariate and multivariate logistic regression analyses were performed to identify independent factors predictive of secondary AUS erosion event. Results A total of 118 patients with history of pelvic radiation (55% salvage, 32% adjuvant, 13% primary radiation) underwent a second AUS implantation at a median of 6.2 months after a prior AUS erosion event. Median age at time of second AUS implantation was 76.6 years and 35% of patients had a history of low testosterone (low T). The overall rate of second AUS device erosion was 47%. The median time to AUS erosion of the initial device was 22.4 months compared to 14.2 months for the second AUS device (p < 0.01). On univariate analysis, history of radiotherapy in the adjuvant (OR 2.54, CI 1.113-5.432, p = 0.034) and salvage (OR 2.66, CI 1.234-4.345, p = 0.012) settings were associated with increased risk of erosion. Uncorrected (OR 2.43, CI 1.143-6.432, p = 0.032) and corrected (OR 2.22, CI 1.116-6.345, p = 0.041) low T as well as history of urethroplasty (OR 2.23, CI 1.231-4.324, p = 0.08) also conferred additional risk of erosion. On multivariate analysis, independent risk factors for a secondary AUS erosion event in radiated patients included uncorrected low T (OR 2.03, 95% CI 1.435-3.456, p = 0.041), history of urethroplasty (OR 2.14, 95% CI 1.123-4.237, p = 0.045), and salvage radiotherapy (OR 2.23, 95% CI 1.24-5.435, p = 0.026). Conclusions Radiated patients with a history of salvage radiotherapy, prior urethroplasty, and uncorrected low T contemplating AUS re-implantation following initial AUS device removal for erosion events are at increased risk of repeat erosion events. Disclosure No.