1348 HYPERCONTINENCE AND CUFF EROSION AFTER ARTIFICIAL URINARY SPHINCTER INSERTION: A COMPARISON OF CUFF SIZES AND PLACEMENT TECHNIQUES

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence—Evaluation & Therapy1 Apr 20111348 HYPERCONTINENCE AND CUFF EROSION AFTER ARTIFICIAL URINARY SPHINCTER INSERTION: A COMPARISON OF CUFF SIZES AND PLACEMENT TECHNIQUES Paul Smith, Steven Hudak, and Allen Morey Paul SmithPaul Smith Dallas, TX More articles by this author , Steven HudakSteven Hudak Dallas, TX More articles by this author , and Allen MoreyAllen Morey Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1169AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have noted that a small percentage of men who undergo placement of an artificial urinary sphincter (AUS) for stress urinary incontinence (SUI) develop transient post-operative urinary retention. Some of these patients become “hypercontinent” requiring prolonged urethral catheterization and/or placement of a suprapubic catheter (SPT). In this study, we evaluated the AUS cuff sizes and techniques associated with hypercontinence. METHODS We analyzed the outcomes of AUS cases performed by a single surgeon from 2007–2010. All patients underwent cuff placement in the most proximal bulb via a perineal incision. Cases were analyzed in three groups according to cuff size–3.5 cm, ≥4.0 cm, or transcorporal cuff (TC). Newer techniques developed for men with periurethral atrophy (3.5 cm cuff and TC cuff) were compared against the traditional cuff size group (≥4 cm). Outcomes relating to urinary retention, SPT placement, and cuff erosion were analyzed. RESULTS Among 138 patients who underwent AUS placement from 2007–2010, 108 cases met inclusion criteria—those placed via a penoscrotal approach or with incomplete follow up data were excluded: 41 men received a 3.5 cm cuff, 46 received a ≥4 cm cuff, and 21 received a TC cuff (all ≥4 cm). TC patients had a significantly higher rate of urinary retention requiring SPT placement compared to the ≥4.0 cm group [5/21 (24%) vs. 2/46 (4%), p = 0.03] and a slightly higher rate than the 3.5 cm group [5/41 (12%), p = 0.3]. The 3.5 cm, ≥4 cm, and TC groups all exhibited similar rates of cuff erosion [3/41 (7%), 2/46 (4%), and 1/21 (5%), p>0.05]. Cuff erosions were much more common in hypercontinent men compared to those without hypercontinence [4/21 (19%) vs 2/87 (2%), p = 0.01], especially in the 3.5 cm and TC group. No significant differences were found between these groups in the rates of diabetes, erectile dysfunction, previous radiation therapy, or previous SUI surgical intervention. CONCLUSIONS Transcorporal AUS placement is associated with a higher rate of postoperative urinary retention and need for suprapubic tube placement compared to traditional 4.0 cm cuff placement. Hypercontinence is a potential risk factor for cuff erosion, likely due to recurrent transurethral instrumentation or prolonged catheterization. The risk of urinary retention requiring further instrumentation and/or SPT placement should be discussed with candidates for TC AUS. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e538-e539 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Smith Dallas, TX More articles by this author Steven Hudak Dallas, TX More articles by this author Allen Morey Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...