Complications following artificial urinary sphincter placement after radical prostatectomy and radiotherapy: a meta-analysis.

Objective To conduct a systematic review and meta-analysis of artificial urinary sphincter ( AUS) placement after radical prostatectomy ( RP) and external beam radiotherapy ( EBRT). Patients and Methods There were 1 886 patients available for analysis of surgical revision outcomes and 949 for persistent urinary incontinence ( UI) outcomes from 15 and 11 studies, respectively. The mean age ( sd) was 66.9 (1.4) years and the number of patients per study was 126.6 (41.7). The mean ( sd, range) follow-up was 36.7 (3.9, 18-68) months. A systematic database search was conducted using keywords, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA) guidelines. Published series of AUS implantations were retrieved, according to the inclusion criteria. The Newcastle-Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA® statistical software. Results AUS revision was higher in RP + EBRT vs RP alone, with a random effects risk ratio of 1.56 (95% confidence interval [ CI] 1.02-2.72; P < 0.050; I2 = 82.0%) and a risk difference of 16.0% (95% CI 2.05-36.01; P < 0.080). Infection/erosion contributed to the majority of surgical revision risk compared with urethral atrophy ( P = 0.020). Persistent UI after implantation was greater in patients treated with EBRT ( P < 0.001). Conclusions Men receiving RP + EBRT appear at increased risk of infection/erosion and urethral atrophy, resulting in a greater risk of surgical revision compared with RP alone. Persistent UI is more common with RP + EBRT. [ABSTRACT FROM AUTHOR]