Abstract
ObjectivesThe objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation.Patients and MethodsData of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009 to 2015. In case of cuff erosion, AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation or mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for 3 weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad test, uroflowmetry, postvoiding residual urine (PVR), and radiography. Primary endpoint was urethral stricture rate.ResultsOut of 235 patients after AUS implantation, 24 (10.2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation, 2 patients (8.3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17 ml/s without suspicion of urethral stricture. Median time to reimplantation was 4 months (IQR 3-4).ConclusionWe observed a considerably low stricture formation and could not prove an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore, the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion.
Highlights
Given the increasing uptake of treatment for benign or malignant prostatic diseases such as radical prostatectomy, radiotherapy, or endoscopic approaches, the incidence of stress urinary incontinence (SUI) resulting from these procedures is rising despite improved surgical techniques [1]
A novel in situ urethroplasty (ISU) technique was superior over Foley catheter alone at the time of cuff erosion regarding both stricture development and the feasibility of secondary artificial urinary sphincter (AUS) implantation, such results have to be interpreted carefully due to inherent selection bias [14]
9 (37.5%) patients had a history of open surgery for SUI, either a male sling or a prior AUS implantation
Summary
Given the increasing uptake of treatment for benign or malignant prostatic diseases such as radical prostatectomy, radiotherapy, or endoscopic approaches, the incidence of SUI resulting from these procedures is rising despite improved surgical techniques [1]. This goes in hand with a profound negative impact on health-related quality of life and increased risk of institutionalization [1]. A novel in situ urethroplasty (ISU) technique was superior over Foley catheter alone at the time of cuff erosion regarding both stricture development and the feasibility of secondary AUS implantation, such results have to be interpreted carefully due to inherent selection bias [14]
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