Ron Golan1, Neal A Patel1, Tianyi Sun2, Christopher E Barbieri1, Art Sedrakyan2, James A Kashanian3. 1. Department of Urology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA. 2. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA. 3. Department of Urology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA. Electronic address: jak9111@med.cornell.edu.
Abstract
INTRODUCTION: Considering that radiation therapy (RT) compromises soft tissue microvasculature, impairs wound healing, and causes cavernosal fibrosis, inflatable penile prosthesis (IPP) outcomes may be adversely affected in men treated with RT. AIM: To compare IPP outcomes among those who had undergone prior RT vs a cohort who underwent radical prostatectomy (RP) before insertion of IPP. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare Database was queried for men with prostate cancer (PCa) who underwent RT (n = 83,277) or RP (n = 32,608) with subsequent IPP insertion between 2002 and 2013. Men who had undergone both RT and RP were excluded from the analysis. MAIN OUTCOME MEASURE: The primary outcome was reoperation, defined by removal, revision, or replacement of the IPP. RESULTS: We identified 350 men who received an IPP following RT and 653 who received an IPP following RP. Men who underwent RT were older (P < .01) and had more comorbidities (P < .01). There were no significant differences in overall reoperation rates at 90 days (P = .78), 1 year (P = .52), or 3 years (P = .48). Time-to-event analysis demonstrated that RT was not associated with an increased likelihood of overall reoperation (hazard ratio [HR] 1.46, 95% confidence interval [CI] 0.94-2.29, P = .09). There was no association between time from RT to IPP and overall reoperation rates. CLINICAL IMPLICATIONS: Prior RT for the treatment of PCa does not impact the revision or removal rates of IPPs as compared with a cohort of non-radiated patients who underwent RP. STRENGTH & LIMITATIONS: The strength includes the analysis of outcomes among a contemporary, nationwide cohort with robust follow-up. Using diagnosis and procedure codes, we were thoroughly able to capture reoperations. Limitations include the lack of specific indications for reoperation and inability to control for surgeon experience or technique. CONCLUSION: IPP is a safe and effective treatment of erectile dysfunction that should be offered to men with a history of pelvic radiation who have failed medical therapy. Golan R, Patel NA, Sun T, et al. Impact of pelvic radiation therapy on inflatable penile prosthesis reoperation rates. J Sex Med 2018;15:1653-1658. Published by Elsevier Inc.
INTRODUCTION: Considering that radiation therapy (RT) compromises soft tissue microvasculature, impairs wound healing, and causes cavernosal fibrosis, inflatable penile prosthesis (IPP) outcomes may be adversely affected in men treated with RT. AIM: To compare IPP outcomes among those who had undergone prior RT vs a cohort who underwent radical prostatectomy (RP) before insertion of IPP. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare Database was queried for men with prostate cancer (PCa) who underwent RT (n = 83,277) or RP (n = 32,608) with subsequent IPP insertion between 2002 and 2013. Men who had undergone both RT and RP were excluded from the analysis. MAIN OUTCOME MEASURE: The primary outcome was reoperation, defined by removal, revision, or replacement of the IPP. RESULTS: We identified 350 men who received an IPP following RT and 653 who received an IPP following RP. Men who underwent RT were older (P < .01) and had more comorbidities (P < .01). There were no significant differences in overall reoperation rates at 90 days (P = .78), 1 year (P = .52), or 3 years (P = .48). Time-to-event analysis demonstrated that RT was not associated with an increased likelihood of overall reoperation (hazard ratio [HR] 1.46, 95% confidence interval [CI] 0.94-2.29, P = .09). There was no association between time from RT to IPP and overall reoperation rates. CLINICAL IMPLICATIONS: Prior RT for the treatment of PCa does not impact the revision or removal rates of IPPs as compared with a cohort of non-radiatedpatients who underwent RP. STRENGTH & LIMITATIONS: The strength includes the analysis of outcomes among a contemporary, nationwide cohort with robust follow-up. Using diagnosis and procedure codes, we were thoroughly able to capture reoperations. Limitations include the lack of specific indications for reoperation and inability to control for surgeon experience or technique. CONCLUSION: IPP is a safe and effective treatment of erectile dysfunction that should be offered to men with a history of pelvic radiation who have failed medical therapy. Golan R, Patel NA, Sun T, et al. Impact of pelvic radiation therapy on inflatable penile prosthesis reoperation rates. J Sex Med 2018;15:1653-1658. Published by Elsevier Inc.
Authors: Marc J Rogers; Marigdalia K Ramirez-Fort; James A Kashanian; Seth A Broster; Jaime Matta; Sean S Mahase; Digna V Fort; M Junaid Niaz; Shearwood McClelland; Neil H Bander; Migdalia Fort; Christopher S Lange; Peter Schlegel; John P Mulhall Journal: Rep Pract Oncol Radiother Date: 2020-05-06