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Perineal Urethral Closure for Stress Urinary Incontinence in the Post Prostate Cancer Devastated Bladder Outlet
Sai Allu, BA, Borivoj Golijanin, BS, Kennon Miller, MD, Madeline J. Cancian, MD.
Warren Alpert Medical School, Providence, RI, USA.

BACKGROUND: Stress urinary incontinence (SUI) is a common complication following prostate cancer surgery. Unfortunately, the artificial urinary sphincter (AUI), the gold standard for treatment of SUI, does not yield satisfactory results in all men. Some men fail AUS or independently develop a devastated bladder outlet, resulting in persistent SUI per urethra which cannot be salvaged with available continence surgeries. The goal of our study was to look at the success rates of perineal urethral closure in this difficult patient population.
METHODS: Patients that underwent urethral closure via the perineum to treat refractory post-prostate cancer urinary incontinence from a single institution between 1/1/2010 to 1/1/2022 were retrospectively reviewed. Data collected included patient demographics, prostate cancer therapies, and surgical history. The primary outcome of the study was the number of patients that remained dry following their initial urethral closure surgery.
RESULTS: Six men with an average age of 83-years (range 75-91) underwent urethral closure in the studied time period. Additional patient characteristics are shown in Table 1. The average number of AUS implanted prior to urethral closure was 1.8 (range 0-3). Two patients had undergone XRT for prostate cancer. Average time from date of initial prostate cancer treatment to urethral closure was 19.5 years (range 3-30). Four of the six patients (66%) were dry per perineum after initial urethral closure. Of the remaining two, one became spontaneously dry seven weeks after surgery and the other underwent a transabdominal bladder neck closure. Average follow up after urethral closure was 28 months (range 6 - 77). At last follow up, five patients had an suprapubic tube (SPT) and one was catheterizing an augmented bladder. All were dry per perineum
CONCLUSIONS: This is the largest patient cohort describing success rates of urethral closure in the setting of post-prostate cancer refractory SUI. All patients became dry at the date of last follow up, with only one requiring an additional surgery to achieve continence. Although a limited sample size, these experiences support that perineal urethral closure is an effective way to attain urinary incontinence in this very difficult patient population.

Table 1: Characteristics of patients undergoing perineal urethral closure for stress urinary inconti

Patient	Age at Urethral Closure (yr)	Current or former smoker	Diabetic	XRT for PCa	Urethral Sling Placed	# of AUS	Urethral stricture or Bladder neck contracture	Dry after initial surgery	Current Status
1	77	Yes	Yes	No	Yes	3	Yes	No	SPT
2	75	Yes	Yes	Yes	Yes	0	No	Yes	Cathing augmented bladder
3	80	No	No	Yes	No	2	No	Yes	SPT
4	87	No	No	No	No	2	No	Yes	SPT
5	91	No	No	No	No	3	Yes	No	SPT into neobladder
6	88	Yes	No	No	No	1	No	Yes	SPT

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