Impact of preoperative factors on recovery of continence after Artificial Urinary Sphincter implantation in Post-Prostatectomy Incontinence

ABSTRACT Background The purpose of this study was to determine the influence of preoperative factors on the recovery of continence after Artificial Urinary Sphincter implantation in Post Prostatectomy Incontinence. Methods 72 patients who underwent AUS implantation between April 2006 to March 2020 were analyzed. The clinical features and preoperative urodynamic parameters were correlated with the postoperative continence rate using linear and logistic regression analysis. The recovery of continence was defined by the patient requiring no use of a protective urine pad during the 24 hours. Results Of the 72 patients, 57 (79.2%) recovered continence (dry group) while 15 (20.8%) were wearing more than 1 pad per day (wet group) on the last follow-up visit. In the clinical characteristics, only the interval between radical prostatectomy and AUS (in months) showed a statistically significant difference (35.4 ± 26.2 in the dry group, 22.7 ± 12.2 in the wet group, p=0.009). Other preoperative clinical features such as the underlying disease, surgical methods, size of prostate, tumor stage and radio nor hormonal therapy did not present statistically significant differences. Of the preoperative urodynamic parameters, only the ALPP showed statistical significance when related to surgical outcomes by 88.6 ± 33.6 in the dry group and 66.1 ± 29.6 in wet the group (P=0.024). The number of patients for whom ALPP was higher than 80 cm H2O was 61.4% in dry group and 20% in wet group (95% confidence interval 1.612-25.11). Other preoperative UDS features including detrusor underactivity, MUCP and others were not statistically significant. Conclusions The interval between RP and AUS, as well as the preoperative ALPP, can be possible predictive factors for the surgical outcomes of AUS implantation. Additionally, an ALPP of > 80 cm H2O has a high degree of predictability for success of AUS surgical outcomes in post-RP incontinence.