Is Removal of the Pressure-regulating Balloon Necessary After Artificial Urinary Sphincter Cuff Erosion?

Abstract

To characterize the risk of delayed infectious complications from retained pressure-regulating balloons (PRBs) after artificial urinary sphincter (AUS) cuff erosion. From our database of 530 AUS cases between 2007 and 2016, we identified 40 total AUS cuff erosions. Twenty-four (60%) presented without evidence of gross device infection and underwent explant of cuff and pump without removal of the PRB. Space of Retzius (SoR) and high submuscular (HSM) balloon locations were analyzed to assess for ease of removal. Presenting clinical features and retained balloon-related outcomes are reported. Of the 24 AUS cuff erosions with retained balloons, 6 (25%) men subsequently required PRB removal for infection during the median follow-up of 36 months (interquartile range 29-53). The median time to balloon infection after AUS erosion surgery was 4 months (interquartile range 4-16). Infection risk was reduced in those without concurrent inflatable penile prosthesis (20%) and in those who underwent "drain and retain" of the PRB (13%). The most common presenting clinical symptoms with retained PRB infection were pain and erythema near the site of the PRB (83%). No patient developed sepsis-related complications. The location of the PRB in this subcohort included 2 SoR and 4 HSM placements. The median operative time for balloon removal in the SoR was 3.5 times greater than that for HSM PRBs (133 minutes vs 38 minutes). With extended follow-up, three-quarters of the men with retained PRBs after AUS cuff erosion experienced no infectious complications. Removal of infected SoR PRBs was associated with greater operative times and surgical complexity relative to HSM PRBs.