Urethral Buttressing in Patients Undergoing Artificial Urinary Sphincter Surgery

Abstract

We evaluated the safety and feasibility of what we believe to be a novel technique of buttressing the urethra with a fibrin coated collagen fleece in patients undergoing artificial urinary sphincter surgery in the presence of urethral atrophy. A total of 17 consecutive men were treated with urethral buttressing for urethral atrophy during artificial urinary sphincter surgery. Continence, complications and patient reported outcomes were assessed by preoperative and postoperative pad use, chart review, patient interview and validated questionnaires. Mean ± SD followup was 38 ± 3.0 months (median 34, range 23 to 71). One patient was excluded from further evaluation due to accidental iatrogenic urethral injury elsewhere. At 3-month followup the mean improvement in pad use was 5 ± 0.5 pads (median 5, range 2 to 9). Of 16 patients 9 (56%) and 2 (13%) used 1 and 0 pad per day, respectively. According to the Patient Global Impression of Improvement questionnaire, 12 of 16 patients (75%) described their condition as much or very much better after surgery. Mean ± SD postoperative Incontinence Impact Questionnaire and Urogenital Distress Index scores were 2 ± 0.8 (median 1, range 0 to 11) and 4 ± 1.0 (median 3, range 0 to 11), respectively. No intraoperative complications were observed. During followup 2 of 16 patients (13%) underwent placement of a second cuff due to unsatisfactory postoperative continence, 1 (6%) underwent artificial urinary sphincter revision for clean urethral erosion and 1 (6%) underwent revision for pump malfunction. Urethral buttressing with a collagen fleece appears to be a safe, feasible option for urethral atrophy in patients treated with artificial urinary sphincter implantation or revision.