PD29-02 OUTCOMES OF URETHROPLASTY TO TREAT STRICTURES ARISING FROM ARTIFICIAL URINARY SPHINCTER (AUS) EROSIONS AND RATES OF SUBSEQUENT AUS REIMPLANTATION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2017PD29-02 OUTCOMES OF URETHROPLASTY TO TREAT STRICTURES ARISING FROM ARTIFICIAL URINARY SPHINCTER (AUS) EROSIONS AND RATES OF SUBSEQUENT AUS REIMPLANTATION Sorena Keihani, Jason C. Chandrapal, Andrew C. Peterson, Joshua A. Broghammer, Nathan Chertack, Sean P. Elliott, Keith F. Rourke, Nejd F. Alsikafi, Jill C. Buckley, Thomas G. Smith, Bryan B. Voelzke, Lee C. Zhao, William O. Brant, and Jeremy B. Myers Sorena KeihaniSorena Keihani More articles by this author , Jason C. ChandrapalJason C. Chandrapal More articles by this author , Andrew C. PetersonAndrew C. Peterson More articles by this author , Joshua A. BroghammerJoshua A. Broghammer More articles by this author , Nathan ChertackNathan Chertack More articles by this author , Sean P. ElliottSean P. Elliott More articles by this author , Keith F. RourkeKeith F. Rourke More articles by this author , Nejd F. AlsikafiNejd F. Alsikafi More articles by this author , Jill C. BuckleyJill C. Buckley More articles by this author , Thomas G. SmithThomas G. Smith More articles by this author , Bryan B. VoelzkeBryan B. Voelzke More articles by this author , Lee C. ZhaoLee C. Zhao More articles by this author , William O. BrantWilliam O. Brant More articles by this author , and Jeremy B. MyersJeremy B. Myers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1354AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral stricture can result after AUS cuff erosion. There is limited data describing the success of urethroplasty and the rate of AUS reimplantation in these patients. We hypothesized that urethroplasty and AUS reimplantation was feasible in most men. METHODS From 2009-2016, we identified patients from Trauma and Urologic Reconstruction Network of Surgeons (TURNS) database, as well as the Cleveland Clinic, Duke University, and University of Alberta. We included patients with a history of urethral stricture arising from AUS erosion who underwent urethroplasty ± subsequent AUS reimplantation. Information was gathered on demographics, initial AUS placement, stricture and urethroplasty specifics, AUS reimplantation, and outcomes. In results analysis we included men with follow up of > 3 months. RESULTS 31 men were identified. Mean age was 73.2 y (SD: 7.0). Radical prostatectomy was the etiology of incontinence in 87%, with 33% having radiation therapy. Prior to urethroplasty, patients had a median of 3 (range: 2-9) urethral operations. Mean duration of initial AUS was 43.4 months (SD: 39.9, range: 1-144) prior to erosion. Mean stricture length was 1.7 cm (SD: 0.8, range 0.5-4.5) found within the bulbar urethra in all cases (9 proximal, 16 middle, 6 distal). Anastomotic (28) and buccal graft substitution (3) urethroplasty were performed. 3/28 patients who had a urethrogram post-operatively had contrast extravasation; all resolved with observation. Post-operative complications included: wound infection (3), and myocardial infarction (1). 29 men had follow up > 3 months. Follow up cystoscopy was performed in 28 patients at a median of 4.5 months (range 2-42) and showed no recurrences. Overall mean follow up was 28.2 months (SD: 16.2, range 6.5-71). Two men had stricture recurrence, but these occurred after AUS reimplantation and repeat erosion. In 27 men (87%), AUS was replaced at mean of 6.2 months (SD: 2.6, range 3-13) after urethroplasty, with either transcorporal placement (18) or standard technique (9). 25 men had follow-up > 3 months after AUS (mean 23.1 months, SD: 15.1, range 4-57); operative complications occurred in 11/25 patients (44%) and included: pump migration (2), sub-cuff atrophy (3), and erosion (6). The 19 men with AUS remaining reported ≤1 pad per day leakage. CONCLUSIONS In patients with urethral stricture after AUS erosion, urethroplasty is very successful and AUS reimplantation rates are high. However, AUS reimplantation after urethroplasty has a high erosion rate even in the short-term. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e572 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sorena Keihani More articles by this author Jason C. Chandrapal More articles by this author Andrew C. Peterson More articles by this author Joshua A. Broghammer More articles by this author Nathan Chertack More articles by this author Sean P. Elliott More articles by this author Keith F. Rourke More articles by this author Nejd F. Alsikafi More articles by this author Jill C. Buckley More articles by this author Thomas G. Smith More articles by this author Bryan B. Voelzke More articles by this author Lee C. Zhao More articles by this author William O. Brant More articles by this author Jeremy B. Myers More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...