Transurethral balloon dilation (BD) is a minimally invasive treatment for urethral stricture disease (USD) performed primarily or as a recurrence salvage maneuver. With the introduction of drug-coated balloons, we sought to characterize patient outcomes using non-medicated balloons. A retrospective review identified patients who underwent BD from 2007 to 2021. Patient and stricture characteristics were collected. All dilations employed the 24Fr UroMaxTM system. Clinical failure was defined by patient-reported lower urinary tract symptom recurrence or need for further stricture management. Ninety-one patients underwent BD with follow-up median (IQR) 12 (3–40) months. Most (75/91, 82%) had prior treatment for USD (endoscopic 50/91 (55%), 51/91 (56%) urethroplasty) before BD. Recurrence rates did not significantly differ between treatment-naïve and salvage patients (44% vs. 52% (p = 0.55)). Median (IQR) time to failure was 6 (3–13) months. The most common complications were urinary tract infection (8%) and post-operative urinary retention requiring catheterization (3%). Radiation history was noted in 33/91 (36%) with 45% recurrence. Patients without previous radiation had a similar recurrence rate of 52% (p = 0.88). Balloon dilation had minimal complications and overall, 50% recurrence rate, consistent regardless of stricture characteristics, radiation history, or prior treatments. These results represent an important clinical benchmark for comparing outcomes using drug-coated balloons.

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Aims: To evaluate the relationship between serum testosterone (T) levels and artificial urinary sphincter (AUS) cuff erosion in a population of incontinent men who underwent AUS placement.Methods: A retrospective analysis of our single-surgeon AUS database was performed to identify men with T levels within 24 months of AUS placement.Men were stratified into two groups based on serum testosterone: low serum testosterone (LT) (<280 ng/dl) and normal serum testosterone (NT) (>280 ng/dl).Multivariable analysis was performed to control for risk factors. The outcome of interest was the incidence of and time to spontaneous urethral cuff erosion; other risk factors for cuff erosion were also evaluated.Results: Among 161 AUS patients with serum testosterone levels, 84 (52.2%) had LT (mean: 136.8 ng/dl, SD: 150.4 ng/dl) and 77 (47.8%) had NT (mean: 455.8 ng/dl, SD: 197.3 ng/dl). Cuff erosion was identified in 42 men (26.1%) at a median of 7.1 months postoperatively (interquartile range: 3.6-13.4 months), most of whom (30/42, 71.4%) were testosterone deficient. LT levels were less common (54/119, 45.4%) in the non-erosion cohort (p = 0.004). Men with low T were nearly three times as likely to suffer AUS erosion than men with normal T (odds ratio = 2.519, p = 0.021). LT level was the only factor associated with AUS erosion on multivariable analysis. Conclusions:LT is an independent risk factor for AUS cuff erosion. Men with LT are more likely to present with cuff erosion, but there is no difference in time to erosion.

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Purpose: To characterize the most common presentation and clinical risk factors for artificial urinary sphincter (AUS) cuff erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these patients. Materials and Methods: We retrospectively reviewed our tertiary center database to identify men who presented with AUS cuff erosion between 2007 -2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for symptom comparison. Risk factors for cuff erosion -pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) -were recorded for each patient. Presenting signs and symptoms of cuff erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (SI). Results: Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) sustained cuff erosion. Most erosion patients (40/61, 66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling. Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with SI or obstructive symptoms presented significantly earlier than those with worsening incontinence (SI 14 ± 18 vs. obstructive symptoms 15 ± 16 vs. incontinence 37 ± 48 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n=61), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 49%, p=0.02). Conclusion: AUS cuff erosion most commonly presents as SI symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.