(177) Androgen Deprivation Therapy Does Not Increase Rates for Reintervention, Complication, or Infection in Penile Implant or Artificial Urinary Sphincter Surgery
Authors: Prebay Z , Fu D , Hochberg A , Im B , Shah S , Chung P 
Published: February 2024

Abstract

Introduction
Prostate cancer treatment carries significant quality of life implications, namely erectile dysfunction and stress urinary incontinence. Treatment options include genitourinary implants such as inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS). Given the association with androgens and penile and urethral health, there may be concern patients on androgen deprivation therapy (ADT) could have worse outcomes following IPP and AUS.

Objective
To evaluate whether patients on ADT undergoing IPP and AUS surgery are at increased risk for reintervention, complication, and infection.

Methods
We queried TriNetX, a collaborative research enterprise, for all adult male patients undergoing AUS or IPP. Cohorts were defined by those taking ADT 3 months before or anytime after surgery and those not taking ADT. ADT medications included: leuprolide, bicalutamide, flutamide, nilutamide, apalutamde, and darolide. We performed sub-analysis for leuprolide and bicalutamide, the two most prescribed ADT medications. Cohorts and outcomes were defined using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes. We used the impact of age, prostate cancer, history of prostatectomy and history of radiation to generate propensity score matching (PSM). Our primary outcome was need for reintervention (revision, removal, or replacement surgery based on CPT codes). Secondary outcomes included infection rate and complication rate based on ICD-10 codes. Analytics were performed via TriNetX on demographic data which calculated Risk Ratios and were run July 2023.

Results
There were 12,143 patients who received an IPP and 5487 who received an AUS (Table 1), with. 401 and 635 patients on ADT, respectively. Patients on ADT had similar rates of reintervention (9.4% vs 12.9%, RR = 0.72, p = 0.11), complication (17.7% vs 22.8%, RR =0.78, p=0.08), and infection (4.1% vs 4.8%, RR =0.84, p=0.60) for IPP. For bicalutamide, patients had lower complication rates (11.3% vs 18.2%, RR = 0.62, p=0.04) and similar reintervention rates (5.2% vs 9.9%, RR = 0.52, p=0.07). There were less than 10 instances of infection and thus TriNetX rounded these numbers to 10 (denoted by *) as part of a patient safety mechanism. Rates were similar for patients on leuprolide (reintervention: 9.8% vs 8.9%, RR =1.1, p = 0.69, complication: 17.5% vs 17.8%, RR = 0.98, p=0.92, infection: 4.0% vs 4.9%, RR = 0.81, p=0.57). Patients receiving an AUS showed similar rates for reintervention (20.8% vs 24.0% RR =0.87, p=0.17), complications (26.1% vs 25.6%, RR=1.0, p=0.85), and infections (2.3% vs 3.7%, RR=0.61, p=0.13) regardless of ADT. This held true for subanalyses for bicalutamide (reintervention: 22.7% vs 22.3%, RR =1.0, p = 0.92, complication: 27.7% vs 24.6%, RR = 1.1, p=0.43, infection: 3.8%* vs 3.8%*, RR = 1, p=1)., and leuprolide (reintervention: 19.8% vs 23.3%, RR =0.85, p = 0.18, complication: 25.3% vs 28.7%, RR = 0.8, p=0.21, infection: 1.9%* vs 3.2%, RR = 0.59, p=0.17).

Conclusions
Patients with IPP or AUS seemingly do no worse on ADT and in some comparisons even seemed to fare better. Further evaluation into the duration of ADT may provide clinical context, but based on these results, ADT should not limit implant surgery.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.