Long‐term lower urinary tract sequelae following AUS cuff erosion

Abstract

To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. Methods:We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups.Results: A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation.Conclusions: Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions.

Urethral management after artificial urinary sphincter explantation due to cuff erosion

“…Given the lack of management guidelines, the available data are mostly based on retrospective studies, in which the management method is dependent on the institutional standardized surgical protocol or is at the surgeon’s discretion. The various management options available in the literature are summarized in Table 1 [ 3 – 8 ]. It is worth mentioning that in most of the studies the type of AUS was not specified.…”

“…The percentage of patients who developed US after such treatment ranges widely from 8% to 85%. All [ 3 – 7 ] but one [ 4 ] of the studies involved urinary drainage by transurethral catheter only. Kuhlencord et al noted that their study was the first to propose additional drainage through a suprapubic catheter, and it may be one of the reasons for the very high success rate of conservative treatment without surgical intervention in the urethra [ 4 ].…”

“…Search terms related to ‘urethral stricture’, ‘artificial urinary sphincter’, and ‘cuff erosion’ were used in the PubMed database to identify relevant articles. We identified 6 original articles [ 3 – 8 ] that assessed the urethral management of after AUS explantation due to cuff erosion.…”

“…Determining the optimal management of AUS complications is of particular importance in light of the increasing number of patients undergoing surgical treatment and radiotherapy for prostate cancer and endoscopic treatment for bladder outlet obstruction, which may be reflected in the increase in demand for AUS. Cuff erosion is associated with urethral injury, which can cause a number of complications, most notably urethral stricture (US), as well as diverticulum and urethrocutaneous fistula [ 3 ]. The onset of these complications can a delay or in some cases disallow the continence restoration via redo AUS implantation.…”

Management of male stress urinary incontinence in high-risk patients: a narrative review

“…During device explantation, it is recommended that full explant be performed. Various studies have reported lower urinary tract sequelae after explantation, including an incidence of urethral stricture ranging from 12-61.5% (38)(39)(40)(41)(42). Management of the urethra varies and multiple studies have compared urethral catheter placement, suture urethrorrhaphy (also referred to as abbreviated urethroplasty or in situ urethroplasty), and excisional urethroplasty (primary urethral anastomosis) (38)(39)(40).…”