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JU INSIGHT Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary Sphincter
By: Kevin Krughoff, MD, Oregon Urology Institute, Springfield; Andrew C. Peterson, MD, MPH, Duke University School of Medicine, Durham, North Carolina | Posted on: 18 May 2023
Krughoff K, Peterson AC. Bladder neck contractures stabilize after placement of the artificial urinary sphincter. J Urol. 2023;209(5):981-991.
Study Need and Importance
For prostate cancer survivors with stress urinary incontinence and bladder neck contracture (BNC), the optimal approach to artificial urinary sphincter (AUS) placement is uncertain. BNC stability is often pursued prior to AUS placement, with several algorithms reporting successful restoration of continence. The effect of AUS placement on BNC stability, however, has not been previously investigated. Our standard approach is for BNC treatment at time of AUS placement. Based on anecdotal experience with this, we hypothesized that the AUS imparts a BNC-stabilizing effect.
What We Found
We evaluated records of prostate cancer survivors with stress urinary incontinence and ≥1 BNC intervention from 2001-2021. We compared BNC recurrence-free intervals between those who did or did not undergo AUS placement using a survival model conditional on the number of previous BNC interventions. The BNC re-intervention rate was 61% lower with an AUS in place when accounting for the number of prior BNC interventions and commonly described BNC risk factors. The Figure illustrates differences in BNC re-intervention stratified by number of prior BNC interventions. Of 31 patients who underwent synchronous BNC intervention and AUS placement, 1 erosion occurred after 263 days. Of 20 BNC interventions performed with an AUS in situ, 1 erosion occurred 13 years later.
Limitations
While staged algorithms are not utilized at our institution, the potential for selection bias for AUS placement remains. BNC intervention is performed for urinary retention and lower urinary tract symptoms; however, there likely exists inter-provider differences in diagnostic algorithms and thresholds for intervention. Records with obliterated lumens and/or urethral stents were excluded, which limits the scope of these findings.
Interpretation for Patient Care
AUS placement is associated with a lower BNC re-intervention rate. Continence restoration using an AUS should not be delayed or avoided when a BNC is present.
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