October 2023

UROLOGY

CASE REPORT: ARTIFICIAL URINARY SPHINCTER PLACED BEFORE SALVAGE RADIATION THERAPY FOR PROSTATE CANCER

Featuring: Vikas Desai, MD
 
A 48-year-old male underwent a robotic radical prostatectomy for high-risk prostate cancer. He had an aggressive pathology based on the final surgical specimen and was likely going to need adjuvant treatment. He did well with his recovery but had bothersome and severe stress incontinence refractory to conservative measures including Kegel exercises and physical therapy.
 
He was referred to me for consideration of surgical options, as I focus on post-prostatectomy urinary incontinence. He was using over five pads a day and this negatively affected his ability to work and his quality of life.
 
Given his adverse surgical pathology, he was going to need adjuvant/early salvage radiation therapy. Unfortunately, his urinary issues were only likely to progress after this treatment. I discussed the option of an artificial urinary sphincter to help decrease urinary incontinence and restore his quality of life before he started radiation therapy.  
 
An artificial urinary sphincter can be placed as early as six months post-radical prostatectomy for refractory stress urinary incontinence. Additionally, placing an artificial urinary sphincter after radiation therapy is typically associated with higher complication rates. Studies have shown that placing an artificial urinary sphincter before radiation therapy results in acceptable urinary continence rates.
 
The patient’s surgery was successful and uncomplicated. At his three-month follow-up visit, he was nearly 100% improved and is down to one shield daily, used more for safety rather than for leakage.
Vikas Desai, MD

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