Corticosteroid Usage Is Associated With Increased Artificial Urinary Sphincter Reoperation - 19/04/17

Doi : 10.1016/j.urology.2016.07.050

Roderick Clark ^a, Jennifer Winick-Ng ^b, J. Andrew McClure ^b, Blayne Welk ^a,^b,^c,^*
^a Department of Surgery (Urology), Western University, London, ON, Canada
^b Institute for Clinical Evaluative Sciences, London, ON, Canada
^c Department of Epidemiology & Biostatistics, Western University, London, ON, Canada

^*Address correspondence to: Blayne Welk, M.D., M.Sc., Departments of Surgery and Epidemiology & Biostatistics, Western University, Room B4-667, St Joseph's Health Care, 268 Grosvenor St., London, ON N6A 4V2, Canada.Departments of Surgery and Epidemiology & BiostatisticsWestern UniversityRoom B4-667, St Joseph's Health Care, 268 Grosvenor St.LondonONN6A 4V2Canada

Abstract

Objective

To determine if oral corticosteroid use is associated with an increased risk of artificial urinary sphincter (AUS)-related reoperation.

Materials and Methods

Administrative data from Ontario were used to conduct a retrospective cohort study. Men >65 years of age who underwent implantation of an AUS between 2002 and 2013 were included. Prescriptions for oral corticosteroids were identified, and men were considered exposed from the date the prescription was dispensed to 180 days after the expected end of the prescription. The primary outcome was AUS reoperation. Data were analyzed using a Cox proportional hazards model with corticosteroid usage modeled as a time-varying covariate.

Results

We identified 747 men who met our inclusion criteria (median age of 71 years; interquartile range [IQR]: 68-75), of which 592 (79.3%) had a prior radical prostatectomy. The median duration of follow-up was 3.2 years (IQR: 1.3-5.9). One hundred seventy-five (23.4%) patients were exposed to corticosteroids during the study period (median duration of use was 21 days; IQR: 5-100). We identified an AUS reoperation in 176 men (23.6%). After adjusting for age, radiation exposure, and year of implantation, exposure to corticosteroids was significantly associated with the risk of AUS reoperation (hazard ratio: 1.68, 95% confidence interval: 1.03-2.75, P = .04). Radiation after AUS implantation was also significantly associated with AUS reoperation (hazard ratio: 2.07, 95% confidence interval: 1.06-4.07, P = .03).