Artificial Urinary Sphincter Cuff Erosion Research Articles

Editorial Comment.

No AccessJournal of UrologyAdult Urology25 Apr 2023Editorial CommentThis article comments on the following:Urethral Stricture Formation After Artificial Urinary Sphincter Cuff Erosion Is Uncommon in the Absence of Pelvic Radiation George E. Koch George E. KochGeorge E. Koch Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003431.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Adjuvant and salvage radiotherapy after prostatectomy: ASTRO/AUA guideline amendment 2018-2019. J Urol. 2019; 202(3):533-538. Link, Google Scholar 2. . Urethral stricture formation after artificial urinary sphincter cuff erosion is uncommon in the absence of pelvic radiation. J Urol. 2023; 210(1):000-000. Google Scholar Submitted November 14, 2022; accepted March 10, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology22 Mar 2023Urethral Stricture Formation After Artificial Urinary Sphincter Cuff Erosion Is Uncommon in the Absence of Pelvic Radiation Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information George E. Koch Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Expand All Submitted November 14, 2022; accepted March 10, 2023; published 000. Advertisement PDF downloadLoading ...

Presenting signs and symptoms of artificial urinary sphincter cuff erosion.

ABSTRACTPurpose To characterize the most common presentation and clinical risk factors for artificial urinary sphincter (AUS) cuff erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these patients.Materials and Methods We retrospectively reviewed our tertiary center database to identify men who presented with AUS cuff erosion between 2007 – 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for symptom comparison. Risk factors for cuff erosion – pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) – were recorded for each patient. Presenting signs and symptoms of cuff erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (SI).Results Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) sustained cuff erosion. Most erosion patients (40/61, 66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling. Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with SI or obstructive symptoms presented significantly earlier than those with worsening incontinence (SI 14 ± 18 vs. obstructive symptoms 15 ± 16 vs. incontinence 37 ± 48 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n=61), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 49%, p=0.02).Conclusion AUS cuff erosion most commonly presents as SI symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.

MP52-09 SAFETY OF TRANSURETHRAL ENDOSCOPIC TREATMENT IN MEN WITH AN ARTIFICIAL URINARY SPHINCTER: A 15 YEAR ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP52-09 SAFETY OF TRANSURETHRAL ENDOSCOPIC TREATMENT IN MEN WITH AN ARTIFICIAL URINARY SPHINCTER: A 15 YEAR ANALYSIS Corey Weinstein, and Jaspreet Sandhu Corey WeinsteinCorey Weinstein More articles by this author , and Jaspreet SandhuJaspreet Sandhu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Incontinence after prostate treatment (IPT) is an uncommon but highly bothersome complaint for patients. Placement of an artificial urinary sphincter (AUS) is the gold standard treatment for IPT. Transurethral endoscopic treatment (TET) after AUS is typically avoided due to the presumed increased risk of AUS cuff erosion after passage of a cystoscope after AUS placement. We set out to determine the rate of erosion in patients undergoing TET after placement of an artificial urinary sphincter (AUS). METHODS: Patients with AUS devices implanted by two surgeons between January 1, 2006 and January 1, 2021 were examined. Patients undergoing a transurethral procedure were included; those that underwent TET for a work-up of a non-functioning AUS were excluded from analysis. Follow up was calculated by last assessment in the outpatient setting. RESULTS: 124 patients were identified that met inclusion criteria, 71 of which were in patients with a history of radiation therapy (RT). 179 AUS were implanted during the study period. Median follow up was 62.4 months. Mean number of TET was 2.5. Procedures included incision of bladder neck contracture, transurethral resection of bladder tumor, cystolitholapaxy, ureteroscopy, and surveillance cystoscopy. There were 10 device erosions (8%) during the follow up at an average of 26.5 months post AUS placement, 9 of which occurred in patients with a history of RT. CONCLUSIONS: TET is safe in patients post-AUS particularly in radiation naïve patients, and the rate of erosion in patients undergoing TET is similar to reported rates of erosion in all AUS patients within the literature. Further research with multi-institutional collaboration is necessary to better understand the risks of erosion in patients with an AUS device undergoing TET. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e889 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Corey Weinstein More articles by this author Jaspreet Sandhu More articles by this author Expand All Advertisement PDF DownloadLoading ...

When to Suspect Artificial Urinary Sphincter Cuff Erosion: An Analysis of Presenting Signs and Symptoms

ABSTRACT Introduction Presenting signs and symptoms of artificial urinary sphincter (AUS) cuff erosion are not well established in the urological literature. Objective We sought to characterize the most common presentation and clinical risk factors for erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these unfortunate patients. Methods We retrospectively reviewed our large tertiary center database to identify men who presented with cuff erosion between 2007 and 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for comparison. Risk factors for cuff erosion – pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) – were recorded for each patient. Presenting signs and symptoms of erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (“pump-itis”). Results Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) suffered cuff erosion. The vast majority of erosion patients (66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling (Figure). Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with worsening incontinence presented significantly later than those with pump-itis or obstructive symptoms (37 ± 48 vs. 14 ± 18 vs. 15 ± 16 months after AUS insertion, p&amp;lt;0.01). Relative to the non-erosion control group (n=95), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 53%, p=0.03). Rates of ADT (41 vs. 40 %, p = 0.96) and high-grade prostate cancer (39 vs. 38 %, p = 0.91) were similar. There was no difference in age at AUS placement (73 ± 7 vs 68 ± 7 years, p=0.70). Conclusions AUS cuff erosion most commonly presents as scrotal inflammatory symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast

Reconstruction of AUS Cuff Erosion: Defect Size Predicts Prognosis

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 (&amp;lt;33% circumferential defect) and major erosions (&amp;gt; 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

Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach.

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.

Most men with artificial urinary sphincter cuff erosion have low serum testosterone levels.

To evaluate the relationship between serum testosterone (T) levels and artificial urinary sphincter (AUS) cuff erosion in a population of incontinent men who underwent AUS placement. A retrospective analysis of our single-surgeon AUS database was performed to identify men with T levels within 24 months of AUS placement. Men were stratified into two groups based on serum testosterone: lowserum testosterone (LT) (<280 ng/dl) andnormalserum testosterone (NT) (>280 ng/dl). Multivariable analysis was performed to control for risk factors. The outcome of interest was the incidence of and time to spontaneous urethral cuff erosion; other risk factors for cuff erosion were also evaluated. Among 161 AUS patients with serum testosteronelevels, 84 (52.2%) hadLT(mean:136.8 ng/dl, SD: 150.4 ng/dl)and 77 (47.8%) had NT (mean: 455.8 ng/dl, SD: 197.3 ng/dl). Cuff erosion was identified in 42 men (26.1%) at a median of 7.1 months postoperatively (interquartile range:3.6-13.4 months), most of whom (30/42, 71.4%) were testosteronedeficient. LTlevels were less common (54/119, 45.4%) in the non-erosion cohort (p = 0.004). Men with low T were nearly three times as likely to suffer AUS erosion than men with normal T (odds ratio = 2.519,p = 0.021). LT level was the only factor associated with AUS erosion on multivariable analysis. LTis an independent risk factor for AUS cuff erosion. Men with LT are more likely to present with cuff erosion, but there is no difference in time to erosion.

325 Does Urethral Repair Prevent Complications from AUS Cuff Erosions? A Decade of Experience

Artificial Urinary Sphincter (AUS) cuff erosion occurs in 8.5% of cases and requires removal of the device.1 Management options include urethral catheter placement alone or in situ urethroplasty (ISU) at the time of explant. It has previously been reported that stricture rates are higher in patients managed with catheter placement alone versus ISU (85% v 35% respectively)2. To determine the stricture rate in patients who undergo ISU after AUS cuff erosion in a large tertiary referral practice. We performed a retrospective cohort study of patients who underwent AUS removal by a single surgeon, secondary to erosion, from January 2006 to June 2019. We identified those who were managed with ISU at the time of explant. The electronic medical records were reviewed for patient demographics, operative details, and development of stricture at follow up. The degree of urethral erosion was defined by percent of urethral circumferential defect noted intra-operatively or on pre-operative cystoscopy. Urethral patency was studied at follow up with voiding cystourethrogram, retrograde urethrogram or cystoscopy.

138 Androgen Deprivation Therapy is Associated With Urethral Atrophy and Artificial Urinary Sphincter Cuff Erosion

138 Androgen Deprivation Therapy is Associated With Urethral Atrophy and Artificial Urinary Sphincter Cuff Erosion

099 The Natural History of Patients with Artificial Urinary Sphincter Cuff Erosion

099 The Natural History of Patients with Artificial Urinary Sphincter Cuff Erosion

257 Use of a Suprapubic Tube at the Time of Artificial Urinary Sphincter Placement: A Strategy to Avoid Urethral Catheterization in the “at risk” Patient

Prolonged urethral catheterization in a patient with an artificial urinary sphincter (AUS) is problematic. In this situation, cuff erosion is not unusual. Also, though most men will have no difficulty voiding in the first 24 hours after AUS placement, the patient who does presents the surgeon with a dilemma: place a urethral catheter with it’s inherent risks, or place a surprapubic tube (SPT). In an effort to avoid this scenario, those patients who seemed most at risk for urinary retention or cuff erosion following AUS placement had a SPT placed while under anesthesia. We report a single center experience with placement of a SPT at the time of AUS surgery. From July 1, 2017 to July 1, 2018 fifty-eight (58) men underwent surgery to place an AUS. Three (3) of those patients were felt to be at increased risk of post-surgical urinary retention or cuff erosion: 1 patient had had a prior AUS and experienced cuff erosion; 1 patient had a prior transobturator sling and the dissection to place the occlusive cuff was more difficult raising the concern of a post-operative cuff site hematoma; 1 patient has prior episodes of urinary retention related to recurrent bladder neck contractures. While still under anesthesia, these 3 men had a 10Fr SPT placed via percutaneous punch using flexible cystoscopy to fill the bladder and confirm correct tube placement. The SPTs were capped, to be opened if the patient experienced symptoms of urinary retention. All patients were discharged from the hospital on the day of surgery.

Role of androgens for urethral homeostasis.

BackgroundWe observed that patients with hypogonadism are at higher risk to experience artificial urinary sphincter cuff erosion. Sphincter erosions have been found to be associated with urethral atrophy or compromised urethras subsequent to events limiting its blood supply. We therefore analyzed possible mechanisms how a decrease in testosterone serum levels can result decreased urethral blood flow.MethodsIn a cohort of >1,200 urethroplasties, tissue specimens obtained during surgeries were analyzed for expression of androgen receptor (AR), AR-responsive TIE-2 associated with angiogenesis, and the endothelial cell marker CD31 for determination of vessel counts were analyzed immunohistochemically. A total of 11 patients were included in whom both tissue and serum testosterone levels within 2 years of the urethroplasty was available. Low serum testosterone level defined as <280 ng/dL. Image J software was used to analyze expression profiles.ResultsMean serum testosterone level was significant lower in hypogonadal patients (179.4 ng/dL) compared to eugonadal patients (375.0 ng/dL, P=0.003). Urethral tissue of hypogonadal patients showed decreased AR expression [1.11% high power field (HPF)] compared to eugonadal patients (1.62%, P=0.016), decreased TIE-2 expression (1.84% HPF vs. 3.08%, P=0.006), and also decreased vessel counts (44.47 vessels/HPF vs. 98.33, P=0.004). There was a direct correlation of AR and TIE-2 expression levels with serum testosterone levels (rho 0.685, P=0.029, and rho 0.773, P=0.005, respectively). Of note, we did not detect a difference in age, prior radiation, coronary artery disease or hypertension among hypo- or eugonadal patient. However, higher body mass index was associated with low serum testosterone levels.ConclusionsHypogonadal status is associated with decreased expression of AR and TIE-2 and also reduced vessel count in urethral tissue. We believe that the resulting decreased urethral vascularity subsequent to a hypogonadal state may be an important risk factor for complications of urethral surgery.

Re: Low Serum Testosterone is Present in Nearly Half of Men Undergoing Artificial Urinary Sphincter Placement.

Objectives To report the prevalence of low serum testosterone (LST) in men undergoing artificial urinary sphincter (AUS) placement at a single high-volume institution. Methods We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from January 2015 to January 2018 to identify men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL. Patients with only posttreatment testosterone levels were excluded. Demographic characteristics and clinical outcomes were compared between men with and without LST. Results Among 113 patients who underwent AUS with pretreatment serum testosterone levels drawn an average of 2.2 months before AUS surgery, 45.1% (51 of 113) met criteria for LST, including 18 patients on androgen deprivation therapy. The rate of primary LST was 34.7% (33 of 95). The median total serum testosterone level among men with LST was 118 ng/dL (interquartile range 6-211), and 413 mg/dL (interquartile range 333-550) in the normal serum testosterone group. There were no differences in patient age, history of radiation, erectile dysfunction, or other comorbidities between the groups. Body mass index was higher in the LST group compared to normal serum testosterone (30 vs 27 kg/m2, P = .001). Cuff size and rates of transcorporal cuff placement were similar between groups. Conclusion Nearly one-half of men with stress urinary incontinence undergoing AUS placement present with LST. While AUS cuff erosion appears to be more common in men with LST, further study is needed to determine if treating LST will reduce cuff erosion rates.

Low Serum Testosterone is Present in Nearly Half of Men Undergoing Artificial Urinary Sphincter Placement

To report the prevalence of low serum testosterone (LST) in men undergoing artificial urinary sphincter (AUS) placement at a single high-volume institution. We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from January 2015 to January 2018 to identify men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL. Patients with only posttreatment testosterone levels were excluded. Demographic characteristics and clinical outcomes were compared between men with and without LST. Among 113 patients who underwent AUS with pretreatment serum testosterone levels drawn an average of 2.2 months before AUS surgery, 45.1% (51 of 113) met criteria for LST, including 18 patients on androgen deprivation therapy. The rate of primary LST was 34.7% (33 of 95). The median total serum testosterone level among men with LST was 118 ng/dL (interquartile range 6-211), and 413 mg/dL (interquartile range 333-550) in the normal serum testosterone group. There were no differences in patient age, history of radiation, erectile dysfunction, or other comorbidities between the groups. Body mass index was higher in the LST group compared to normal serum testosterone (30 vs 27 kg/m2, P = .001). Cuff size and rates of transcorporal cuff placement were similar between groups. Nearly one-half of men with stress urinary incontinence undergoing AUS placement present with LST. While AUS cuff erosion appears to be more common in men with LST, further study is needed to determine if treating LST will reduce cuff erosion rates.

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

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 ...

199 Is Removal of the Pressure Regulating Balloon Necessary after Artificial Urinary Sphincter Cuff Erosion?

To characterize the fate of the retained pressure regulating balloons (PRB) after artificial urinary sphincter (AUS) cuff erosion. Between 2007-2016 at our institution, there were 40 total AUS cuff erosions. Twenty-four (60%) presented without evidence of device infection and underwent explant of cuff and pump without removal of the PRB. Both Space of Retzius (SoR) and high submuscular (HSM) balloon locations were included. Presenting clinical features and retained balloon-related outcomes are reported. Of the 24 AUS cuff erosions with retained balloons, 6 (25%) men subsequently required PRB removal for infection during a median follow-up of 36 months (IQR 29-53). The most common presenting clinical symptoms with retained PRB infection were pain and erythema near the site of the PRB (83%). No patient developed sepsis-related complications. Median time to balloon infection after AUS erosion surgery was 4 months (IQR 4-16). Location of the PRB in this subcohort included 2 SoR and 4 HSM placements. Median operative time for balloon removal in the SoR was 3.5 times greater than for HSM PRBs (133 minutes vs. 38 minutes).

Is Removal of the Pressure-regulating Balloon Necessary After Artificial Urinary Sphincter Cuff Erosion?

To characterize the risk of delayed infectious complications from retained pressure-regulating balloons (PRBs) after artificial urinary sphincter (AUS) cuff erosion. From our database of 530 AUS cases between 2007 and 2016, we identified 40 total AUS cuff erosions. Twenty-four (60%) presented without evidence of gross device infection and underwent explant of cuff and pump without removal of the PRB. Space of Retzius (SoR) and high submuscular (HSM) balloon locations were analyzed to assess for ease of removal. Presenting clinical features and retained balloon-related outcomes are reported. Of the 24 AUS cuff erosions with retained balloons, 6 (25%) men subsequently required PRB removal for infection during the median follow-up of 36 months (interquartile range 29-53). The median time to balloon infection after AUS erosion surgery was 4 months (interquartile range 4-16). Infection risk was reduced in those without concurrent inflatable penile prosthesis (20%) and in those who underwent "drain and retain" of the PRB (13%). The most common presenting clinical symptoms with retained PRB infection were pain and erythema near the site of the PRB (83%). No patient developed sepsis-related complications. The location of the PRB in this subcohort included 2 SoR and 4 HSM placements. The median operative time for balloon removal in the SoR was 3.5 times greater than that for HSM PRBs (133 minutes vs 38 minutes). With extended follow-up, three-quarters of the men with retained PRBs after AUS cuff erosion experienced no infectious complications. Removal of infected SoR PRBs was associated with greater operative times and surgical complexity relative to HSM PRBs.

Prior Radiation Therapy Decreases Time to Idiopathic Erosion of Artificial Urinary Sphincter: A Multi-Institutional Analysis

Substantial controversy and conflicting data exist regarding the survival of the artificial urinary sphincter in patients with prior radiation therapy. We present data from a multi-institutional analysis examining the effect of prior radiation for prostate cancer on device survival. A database was compiled of patients with artificial urinary sphincter cuff erosion, which included demographic and comorbid patient characteristics, functional analyses and interventions. We identified 80 patients with iatrogenic or idiopathic artificial urinary sphincter erosion. Idiopathic erosion cases were further analyzed to determine factors influencing device survival with specific stratification for radiation therapy. A total of 56 patients were identified with idiopathic artificial urinary sphincter erosion. Of those men 33 (58.9%) had not undergone radiation treatment while 23 (41.1%) had a history of brachytherapy or external beam radiotherapy. In patients without radiation erosion-free median device survival was 3.15 years (95% CI 1.95-5.80), in contrast to the median device survival of only 1.00 year (95% CI 0.36-3.00) in irradiated patients. The erosion-free survival experience of patients with vs without radiation differed significantly (Wilcoxon-Breslow test for equality of survivor functions p = 0.03). Radiation therapy in patients with known idiopathic cuff erosion in this contemporary analysis correlated with significantly increased time to erosion. Mean time to idiopathic cuff erosion was accelerated by approximately 2 years in irradiated cases. To our knowledge these data represent the first demonstration of substantial outcome differences associated with radiation in patients with an artificial urinary sphincter who present specifically with cuff erosion.

MP46-04 HIGH PREVALENCE OF LOW SERUM TESTOSTERONE LEVELS AMONG ARTIFICIAL URINARY SPHINCTER PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-04 HIGH PREVALENCE OF LOW SERUM TESTOSTERONE LEVELS AMONG ARTIFICIAL URINARY SPHINCTER PATIENTS Travis Pagliara, Jeremy Scott, Boyd Viers, and Allen Morey Travis PagliaraTravis Pagliara More articles by this author , Jeremy ScottJeremy Scott More articles by this author , Boyd ViersBoyd Viers More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent evidence suggests that low serum testosterone (LST) may be associated with artificial urinary sphincter (AUS) cuff erosion. While the role of androgen replacement therapy is currently poorly defined among men receiving AUS placement surgery, the prevalence of LST among AUS patients is also unknown. We report the prevalence of LST relative to other associated risk factors among a large group of men undergoing AUS placement at a single high-volume institution. METHODS We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from 2012-2016 to identify those men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL. All low serum testosterone levels underwent confirmatory testing. Clinical characteristics were compared between men with and without LST levels. RESULTS Among 85 AUS patients having pretreatment serum testosterone levels available for review, nearly half (41/85, 48%) met criteria for LST. After excluding those patients on androgen deprivation therapy (N=13), 28 of 72 (29%) had primary LST levels. AUS cuff erosion was more common among men with LST levels (38% vs 9%, p=0.01). The median total serum testosterone level among men undergoing AUS placement was 331ng/dL (IQR 192-447). Testosterone levels were drawn at a median 1.5 months (IQR 0-5.8) before AUS surgery. Men with LST levels were more likely to have a history of coronary artery disease (88% vs 30%, p=0.002) and a trend in greater body mass index (mean 31 vs 28, p=0.09) relative to those with normal serum testosterone levels. There was no difference in patient age, history of radiation, time from cancer therapy, erectile dysfunction, or other comorbidities. CONCLUSIONS Approximately one-half of men with stress urinary incontinence undergoing AUS placement present with LST levels. Accordingly, given the association between LST and AUS cuff erosion, men with risk factors for LST should undergo further evaluation prior to SUI surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e620 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Travis Pagliara More articles by this author Jeremy Scott More articles by this author Boyd Viers More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP46-08 URETHRAL STRICTURES ARE NOT AS FREQUENT AS THOUGHT AFTER ARTIFICIAL URINARY SPHINCTER CUFF EROSION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-08 URETHRAL STRICTURES ARE NOT AS FREQUENT AS THOUGHT AFTER ARTIFICIAL URINARY SPHINCTER CUFF EROSION Ramiro Madden-Fuentes, Stephanie Sexton, and Andrew Peterson Ramiro Madden-FuentesRamiro Madden-Fuentes More articles by this author , Stephanie SextonStephanie Sexton More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1447AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Erosion of the artificial urinary sphincter (AUS) cuff is an uncommon problem after implantation of the AUS. The degree of injury secondary to the device erosion may lead to formation of scar around and within the urethra however the rate of secondary clinically significant strictures have not been well reported. We hypothesized that the stricture formation rate after an erosion was almost 100% in these patients and conducted a review of our single center experience to establish the natural incidence of stricture after erosion of the AUS cuff. METHODS We conducted an internal review board approved review of males >18 years old with a history of AUS cuff erosion between January 1st, 2006 and January 31st 2013. Basic demographic, clinical and operative data were recorded. The degree of urethral erosion was stratified into 4 groups for comparison: 1) <25% circumference, 2) 25-50% circumference, 3) >50% and <100% circumference, 4) 100% circumference. A stricture was defined as clinically significant if it required intervention such as urethroplasty, direct visual internal urethrostomy, or dilation. Patients with less than 1 month follow up were excluded for stricture rate analysis. RESULTS A total of 55 males with a history of AUS cuff erosion were identified. The mean patient age was 73.6 (±9.4). The mean device age was 50.5 months (range 1-160). Of the cohort, 47 were initially implanted at our institution and 8 elsewhere. An associated infection was noted in 20 patients. Of 55 patients, 13 (24%) had a prior history of AUS erosion. Of the 55 patients, 21 were in group 1, 13 in group 2, 7 in group 3, 5 in group 4, and the degree of erosion was not documented in 9. The median follow up after erosion in these patients was 9 months. Four patients did not have sufficient follow up to assess stricture rate (less than 1 month). The median length of catheterization was 30 days after removal of the AUS. The degree of erosion did not correlate with a longer period of catheterization (p=0.5). Of the patients with follow up, the overall rate of stricture in this cohort was 25%. The degree of erosion did not correlate with the risk of stricture occurrence (p=0.8). However, in the circumferential erosion group (n=5), 2 underwent a urethroplasty at the time of cuff removal. An infected and eroded cuff did not appear to correlate with a higher risk of stricture formation (p=0.7) CONCLUSIONS Erosion of the AUS cuff into the urethra leads to a urethral stricture in 25% of patients. However, the degree of erosion, prolonged urinary extravasation, or associated infection did not correlate with development of a urethral stricture. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e621-e622 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ramiro Madden-Fuentes More articles by this author Stephanie Sexton More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...