Corticosteroid usage is associated with increased artificial urinary sphincter reoperation

Objective — To determine if oral corticosteroid use is associated with an increased risk of AUS related reoperation.

Methods — Administrative data from Ontario was 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 analysed 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, IQR 68-75), of which 592 (79.3%) had a prior radical prostatectomy. The median duration of follow-up was 3.2 (IQR 1.3-5.9) years. 175 (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 (HR 1.68, 95% CI 1.03-2.75, p=0.04). Radiation after AUS implantation was also significantly associated with AUS reoperation (HR 2.07, 95% CI 1.06-4.07, p=0.03).

Conclusions — There is a significantly increased risk of AUS reoperation among men using oral corticosteroids.