Low Serum Testosterone Level Predisposes to Artificial Urinary Sphincter Cuff Erosion

Hofer, Matthias; Morey, Allen F.; Sheth, Kunj R.; Tausch, Timothy J.; Siegel, Jordan; Cordon, Billy H.; Bury, Matthew I.; Cheng, Earl Y.; Sharma, Arun K.; Gonzalez, Christopher; Kaplan, William E.; Kavoussi, Nicholas; Klein, Alexandra; Roehrborn, Claus G.

doi:10.1016/j.urology.2016.04.065

Cited by 41 publications

(25 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1). Placement of an artificial urinary sphincter in the postoperative period or even at the time of RP would have been a therapeutic alternative; however, we felt that the need for adjuvant RT and potential subsequent systemic therapies could result in an increased complication rate, as has been described recently [19,20]. Low serum testosterone levels and continuous exposure to corticosteroids are associated with a seven-and twofold increased risk, respectively, of experiencing urethral cuff erosions.…”

Section: Discussionmentioning

confidence: 99%

Pelvic exenteration surgery in patients with locally advanced castration‐naïve and castration‐resistant, symptomatic prostate cancer

et al. 2020

View full text Add to dashboard Cite

Objectives To evaluate retrospectively the surgical, symptomatic and oncological outcomes of pelvic exenteration surgery (PES) in men with significant intrapelvic complications of locally advanced castration‐sensitive (CSPC) and castration‐resistant prostate cancer (CRPC). Patients and Methods A total of 103 patients with locally advanced progressive and symptomatic CSPC or CRPC underwent PES (radical cystoprostatectomy, n = 71 [68.9%]; radical prostatectomy with continent vesicostomy, n = 9 [8.7%]; total exenteration, n = 23 [22.3%]). All patients underwent local staging via magnetic resonance imaging, cystoscopy and rectoscopy. Systemic staging was carried out with chest, abdominal and pelvic computed tomography scans and bone scans. Peri‐operative complications were assessed according to Clavien–Dindo classification. Symptom‐free and overall survival were evaluated using the Kaplan–Meier method. Statistical tests were two‐tailed with a P value <0.05 taken to indicate statistical significance. Results After a median (range) follow‐up of 36.5 (3–123) months, the symptom‐free survival rate at 1 and 3 years was 89.2% (n = 89) and 64.1% (n = 66), respectively. The median symptom‐free survival was 27.9 months. A total of 78.6% of the patients were symptom‐free during their remaining lifetime. The overall survival rate at 1 and 3 years was 92.2% and 43.7%, respectively, and the median overall survival was 33.6 months. Clavien–Dindo grades 2, 3 and 4 complications developed in 31 (30.6%), 12 (11.6%) and eight patients (8.1%), respectively. Conclusion Pelvic exenteration surgery is technically feasible in well‐selected patients, resulting in symptom relief in >90% of patients, covering 80% of their remaining lifetime.

show abstract

Section: Discussionmentioning

confidence: 99%

Pelvic exenteration surgery in patients with locally advanced castration‐naïve and castration‐resistant, symptomatic prostate cancer

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, our follow‐up assumption does not account for patients who possibly sought care elsewhere, but this potential bias should affect all patients equally and not substantively change the conclusions of the analysis. Although low serum testosterone has recently been identified as an independent risk factor for AUS cuff erosion , we began consistently checking testosterone levels of AUS patients in 2015. Unfortunately, too few patients in the present cohort had documented testosterone levels to enable analysis of its association with erosion events in the present study.…”

Section: Discussionmentioning

confidence: 99%

Erosion rates of 3.5‐cm artificial urinary sphincter cuffs are similar to larger cuffs

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…We recently identified that hypogonadism is strongly associated with artificial urinary sphincter cuff erosions ( 1 , 2 ). Within 8 years of implantation, we have observed that nearly all (90%) of incontinent men with low testosterone levels can expect to experience erosion of their artificial urinary sphincter.…”

Section: Introductionmentioning

confidence: 99%

Role of androgens for urethral homeostasis

Hofer¹,

Morey²

2018

Transl. Androl. Urol.

Self Cite

View full text Add to dashboard Cite

BackgroundWe observed that patients with hypogonadism are at higher risk to experience artificial urinary sphincter cuff erosion. Sphincter erosions have been found to be associated with urethral atrophy or compromised urethras subsequent to events limiting its blood supply. We therefore analyzed possible mechanisms how a decrease in testosterone serum levels can result decreased urethral blood flow.MethodsIn a cohort of >1,200 urethroplasties, tissue specimens obtained during surgeries were analyzed for expression of androgen receptor (AR), AR-responsive TIE-2 associated with angiogenesis, and the endothelial cell marker CD31 for determination of vessel counts were analyzed immunohistochemically. A total of 11 patients were included in whom both tissue and serum testosterone levels within 2 years of the urethroplasty was available. Low serum testosterone level defined as <280 ng/dL. Image J software was used to analyze expression profiles.ResultsMean serum testosterone level was significant lower in hypogonadal patients (179.4 ng/dL) compared to eugonadal patients (375.0 ng/dL, P=0.003). Urethral tissue of hypogonadal patients showed decreased AR expression [1.11% high power field (HPF)] compared to eugonadal patients (1.62%, P=0.016), decreased TIE-2 expression (1.84% HPF vs. 3.08%, P=0.006), and also decreased vessel counts (44.47 vessels/HPF vs. 98.33, P=0.004). There was a direct correlation of AR and TIE-2 expression levels with serum testosterone levels (rho 0.685, P=0.029, and rho 0.773, P=0.005, respectively). Of note, we did not detect a difference in age, prior radiation, coronary artery disease or hypertension among hypo- or eugonadal patient. However, higher body mass index was associated with low serum testosterone levels.ConclusionsHypogonadal status is associated with decreased expression of AR and TIE-2 and also reduced vessel count in urethral tissue. We believe that the resulting decreased urethral vascularity subsequent to a hypogonadal state may be an important risk factor for complications of urethral surgery.

show abstract

Low Serum Testosterone Level Predisposes to Artificial Urinary Sphincter Cuff Erosion

Cited by 41 publications

References 19 publications

Pelvic exenteration surgery in patients with locally advanced castration‐naïve and castration‐resistant, symptomatic prostate cancer

Pelvic exenteration surgery in patients with locally advanced castration‐naïve and castration‐resistant, symptomatic prostate cancer

Erosion rates of 3.5‐cm artificial urinary sphincter cuffs are similar to larger cuffs

Role of androgens for urethral homeostasis

Contact Info

Product

Resources

About