PD39-02 EROSION RATES OF 3.5 CM ARTIFICIAL URINARY SPHINCTER CUFFS ARE SIMILAR TO LARGER CUFFS

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II1 Apr 2018PD39-02 EROSION RATES OF 3.5 CM ARTIFICIAL URINARY SPHINCTER CUFFS ARE SIMILAR TO LARGER CUFFS Nabeel Shakir, Maxim McKibben, Joceline Fuchs, Jeremy Scott, and Allen Morey Nabeel ShakirNabeel Shakir More articles by this author , Maxim McKibbenMaxim McKibben More articles by this author , Joceline FuchsJoceline Fuchs More articles by this author , Jeremy ScottJeremy Scott More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1914AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the launch of 3.5 cm artificial urinary sphincter (AUS) cuffs in the US market in 2009, the possible increased risk of erosion has been a concern. We sought to compare the outcomes of 3.5 cm AUS cuffs versus larger cuffs for men having stress urinary incontinence (SUI) with and without a history of pelvic radiation after 8 years of experience. METHODS We reviewed the records of all men who underwent AUS placement by a single surgeon between 2009 and 2017 collected in a large, tertiary male SUI database. A uniform perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement. Patients were stratified by cuff size and radiation status, and patient demographics and surgical outcomes were analyzed. Success was defined as patient-reported use of ≤1 pad per day. RESULTS Among 400 AUS cases included in the analysis, the 3.5 cm cuff was used in 164 (41‰) cases, while 236 (59‰) patients received 4.0 cm or larger cuffs. AUS cuff erosion was seen 34 patients, who suffered a total of 44 cuff erosions over a median follow-up of 45 months. Rate of cuff erosion was similar in the 3.5 cm cuff group (12‰, 19/164), compared to the 4+ cm group (11‰, 25/236, p=0.7) (FIGURE). On multivariate logistic regression, predictors of AUS cuff erosion include history of pelvic radiation (OR 7.27, IQR 3.19-16.6, p<0.0001), history of IPP placement (OR 3.63, IQR 1.69-7.81, p=0.0009), and coronary artery disease (OR 4.05, IQR 1.86-8.81, p=0.0005). Patient demographics were similar between the two cuff size groups, including age, BMI, comorbidities, smoking history, radiation history, prior AUS, prior inflatable penile prosthesis (IPP), and proportion of patients with prior erosions. In patients receiving larger cuffs, 19‰ (45/236) were placed using a transcorporal approach, compared to 2‰ (4/164) of those undergoing 3.5 cm cuff placement (p<0.0001). Continence rates were high among all AUS patients, with similar success in both groups (89‰ for 3.5 cm, 82‰ for 4+ cm, p=0.1). CONCLUSIONS After eight years of experience and follow-up, the 3.5 cm AUS cuff behaves similarly to 4+ cm cuffs with respect to efficacy and rates of urethral erosion. Use of any cuff in radiated patients should be approached cautiously, as risk of erosion is substantial. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e798 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nabeel Shakir More articles by this author Maxim McKibben More articles by this author Joceline Fuchs More articles by this author Jeremy Scott More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...