257 Use of a Suprapubic Tube at the Time of Artificial Urinary Sphincter Placement: A Strategy to Avoid Urethral Catheterization in the “at risk” Patient

Abstract

Prolonged urethral catheterization in a patient with an artificial urinary sphincter (AUS) is problematic. In this situation, cuff erosion is not unusual. Also, though most men will have no difficulty voiding in the first 24 hours after AUS placement, the patient who does presents the surgeon with a dilemma: place a urethral catheter with it’s inherent risks, or place a surprapubic tube (SPT). In an effort to avoid this scenario, those patients who seemed most at risk for urinary retention or cuff erosion following AUS placement had a SPT placed while under anesthesia. We report a single center experience with placement of a SPT at the time of AUS surgery. From July 1, 2017 to July 1, 2018 fifty-eight (58) men underwent surgery to place an AUS. Three (3) of those patients were felt to be at increased risk of post-surgical urinary retention or cuff erosion: 1 patient had had a prior AUS and experienced cuff erosion; 1 patient had a prior transobturator sling and the dissection to place the occlusive cuff was more difficult raising the concern of a post-operative cuff site hematoma; 1 patient has prior episodes of urinary retention related to recurrent bladder neck contractures. While still under anesthesia, these 3 men had a 10Fr SPT placed via percutaneous punch using flexible cystoscopy to fill the bladder and confirm correct tube placement. The SPTs were capped, to be opened if the patient experienced symptoms of urinary retention. All patients were discharged from the hospital on the day of surgery.