(537) Transcorporal Cuff vs Standard Cuff Placement of Artificial Urinary Sphincters: A Systematic Review and Meta-Analysis

Abstract

Abstract Introduction Long-term data suggests 1 in 5 patients will require artificial urinary sphincter (AUS) reoperation due to erosion, infection, or mechanical malfunction prior to the end of the natural lifespan of the device. Men with stress incontinence after radiation or prostatectomy are considered to have "fragile" urethras that are higher risk for AUS erosion. Transcorporal cuff placement (TCC) of artificial urinary sphincters (AUS) is thought to have a protective effect by avoiding direct contact with the urethra and thus avoiding erosion. Stress incontinence can detract from libido and overall sexual health and should be an important consideration in cancer survivorship. Objective The objective of the study was to determine if TCC has a protective effect in avoiding complications compared to standard cuff placement for AUS patients. Methods A systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of complication, defined as explant, reoperation/revision, infection, erosion, or mechanical failure. Pooled incidence was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. A total of 14 studies were included, of which 9 provided data for comparative analysis. Results Pooled data from 2240 patients revealed a complication rate of 20% (95% CI 0.14-0.28) (Figure 1). Data from 428 patients were included in the comparative analysis, which showed a 2.11 (95%CI 1.29-3.46) higher odds of explant with TCC compared to standard cuff placement (Figure 2). However, TCC was used mainly in patients with “fragile” urethras, a term used to describe patients with prior AUS erosion, radiation therapy, or other urethral surgeries. Conclusions The current data suggests that TCC may have a higher complication rate compared to standard cuff placement and is not protective against erosion. However, the TCC approach largely targeted patients with multiple risk factors for erosion. A prospective randomized trial comparing TCC to standard cuff placement in a matched patient population may contribute to a better understanding of whether TCC has a protective effect. Disclosure No