Reconstruction of AUS Cuff Erosion: Defect Size Predicts Prognosis

Abstract

ABSTRACT Introduction In-situ urethroplasty (ISU) has been proposed in conjunction with device explant as an acute management strategy after artificial urinary sphincter (AUS) cuff erosion. Previous studies have not shown a clear relationship between extent of erosion and long-term prognosis. Objective We hypothesize that more extensive erosions are associated with higher rates of lower urinary tract complications (LUTC) and increased need for urinary diversion (UD). Methods We performed a retrospective study of patients who underwent ISU for AUS cuff erosion from June 2007 to December 2020 with a minimum of 90-day follow up. Patients were stratified into two groups based on the degree of urethral erosion determined endoscopically at the time of device explant - mild erosions (<33% circumferential defect) and major erosions (> 33%). Outcomes included LUTC, AUS reimplantation, and UD. LUTC was defined as urethral strictures, diverticulum, fistulas, and erosions of a secondary AUS. UD was defined as suprapubic tube placement with or without urethral ligation or ileal conduit creation. Kaplan-Meier curves were created to compare outcomes between groups. Results A total of 40 patients underwent ISU for urethral cuff erosion and met the follow-up criteria. Median patient age was 76 years old with median erosion defect size of 46% (IQR: 20-50%); 15 men (37.5%) had mild erosions and 25 (62.5%) had major erosions. The overall LUTC rate was 53.5% with significantly fewer complications noted with mild erosions (28.6% vs 65.4%, p = 0.002) (Figure 1). Ultimately, 35.0% of patients required permanent UD with decreased rates in the case of mild erosions (13.3% vs 48.0%, p = 0.04) (Figure 2). On Kaplan-Meier analysis, mild erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. Conclusions Prognosis after AUS cuff erosion is associated with size of the urethral defect. Patients with extensive cuff erosion are at high risk for LUTCs and permanent UD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast