(143) Hostile Field: Surgical Management Strategies After Multiple Explants of Artificial Urinary Sphincters

Abstract

Abstract Introduction Placement of artificial urinary sphincters (AUS) is the gold standard treatment for moderate to severe stress urinary incontinence in men. Erosion, infection, and mechanical malfunction of the AUS are well known complications that require removal of the device. Replacement of AUS after several explants represents a surgical challenge and is performed by a minority of urologists. Objective We describe our experience with management of complex cases after multiple AUS complications. Methods Retrospective review of patients who underwent artificial urinary sphincter (AUS) removal after prior device explantations. Surgical and clinical data was collected, including demographic characteristics, indication for AUS explantation, number of prior AUS, presence of an IPP, and surgical outcomes and complications. Descriptive statistics were used for both categorical and nominal variables. Results Between 2017 and 2021, 8 patients presented with recurrent stress urinary incontinence (SUI) with a history of AUS with or without explant. 2 patients presented with one prior AUS, 1 patient with two prior, 4 patients with 3 prior AUS, and 1 patient with 4 prior AUS. 5/8 patients achieved >90% continence following one revision. The remaining patients underwent cuff downsizing. 1 patient failed multiple revisions and required urethral ligation with permanent suprapubic tube placement (SPT). Patient history and surgical course is summarized in Table 1. Conclusions AUS placement after multiple explants presents a surgical challenge. It is associated with a higher rate of complications and need for explant. It is however feasible and safe, and can provide resolution of incontinence to the majority of patients. In patients with a devastated urethra where additional AUS does not seem feasible a urinary diversion or urethral ligation with SPT may be a satisfactory alternative. Disclosure No