Transcorporal Artificial Urinary Sphincter Research Articles

Clinical case of primary transcorporal artificial urinary sphincter cuff implantation

Among surgical methods of treatment of male stress urinary incontinence, implantation of an artificial urinary sphincter is the leading technique. Despite its acceptable effectiveness, the intervention carries a risk of complications, some of which require removal of a component or the entire device.The article presents a clinical case of primary artificial urinary sphincter cuff placement and literature review on this topic.

Management of male stress urinary incontinence in high-risk patients: a narrative review.

The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients. A comprehensive review of current literature was performed utilizing the search term "artificial urinary sphincter" in conjunction with any of the following additional terms: "radiation", "urethral stricture", "posterior urethral stenosis", "vesicourethral anastomotic stenosis", "bladder neck contracture", "pelvic fracture urethral injury", "penile revascularization", "inflatable penile prosthesis", and "erosion". Guidance is provided based upon expert opinion where existing literature was sparse or nonexistent. Several known patient risk factors are associated with AUS failure and can ultimately lead to device explantation. Each risk factor requires careful consideration and investigation, or intervention as appropriate, prior to device placement. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients. Several surgical strategies to decrease device complications can be considered: optimization of testosterone, avoidance of 3.5 cm AUS cuff, transcorporal AUS cuff placement, relocation of AUS cuff site, use of lower pressure-regulating balloon, penile revascularization, and intermittent nocturnal deactivation. A number of patient risk factors are associated with AUS failure and can ultimately lead to device explantation. We present an algorithm for management of high-risk patients. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients.

Complicated artificial urinary sphincter insertion using the transcorporal cuff: keys to the tunical flap technique.

Urethral sphincter insufficiency following radical prostatectomy (RP) is a common cause of non-neurogenic stress urinary incontinence (SUI). Artificial urinary sphincter (AUS) insertion remains the standard of care for fit patients with SUI refractory to non-operative interventions. The proximal urethra is a common location for uncomplicated AUS placement. However, previous failed AUS, urethroplasty, or pelvic radiotherapy (RT) may compromise urethral tissue requiring technique modifications that optimise outcomes. In these situations, transcorporal cuff (TC) placement has been well described to facilitate continence restoration in men where there is no other feasible option other than urinary diversion or permanent incontinence. In the traditional TC approach, the procedure may be complicated by haematoma due to difficulty in completely closing the corporal defects behind the urethra. This narrated video demonstrates the tunical flap (TF) modification for transcorporal AUS implantation via a perineal and penoscrotal approach in patients with prior failed AUS placements secondary to urethral erosion. The TF technique for transcorporal AUS insertion provides circumferential reinforcement with tunica albuginea from the corpora cavernosa. Here, we show how this technique provides additional urethral support for compromised urethral tissue to help prevent cuff erosion. The TF preserves the corporal volume and does not limit candidacy for future penile prosthesis implantation. In our early results, there have been no postoperative haematoma formation with this technique.

Artificial Urinary Sphincter in a High-Risk Urethra: Transcorporal Gullwing Modification Description of the Technique.

In this report, we describe a modification of transcorporal artificial urinary sphincter place ment known as Gullwing modification. Using a penoscrotal approach, bilateral corpora cavernosa flaps are harvested and sutured in the midline covering the lateral and ventral surfaces of the urethra. Transcorporal cuff placement provides dorsal reinforcement, thus having extra tissue buttressing all the circumference in cases of a fragile urethra due to previous urethral cuff erosion, urethroplasty, or pelvic radiotherapy. After previous urethral cuff erosion, radiotherapy, and urethral reconstruction, our patient complained of severe stress urinary incontinence. Due to the high risk of urethral complications, we proceed to a transcorporal artificial sphincter placement with urethral reinforcement through a bilateral cavernosal flap. The surgery was successfully completed, and after 6 weeks, sphincter was activated with satisfac tory results. Two years after surgery, his continence status is stable without complications. Urethral complications associated with artificial urinary sphincter surgery remain a challenge for the reconstructive surgeon. Reinforcement of the ventral aspect of the urethra through corpora cavernosal flaps may reduce the likelihood of urethral erosion in high-risk cases.

The Gullwing Technique: A Novel Method of Transcorporal Artificial Urinary Sphincter Placement for the Fragile Urethra

To describe the novel gullwing technique for artificial urinary sphincter (AUS) placement. The transcorporal technique for AUS placement is beneficial in patients with 'fragile urethras' (previous failed AUS, urethroplasty or history of radiation) however limitations include insufficient lateral and ventral urethral support in addition to potential cinching during corporotomy closure which, in the absence of additional grafting may restrict our ability to conserve internal corporal capacity and limit options for future preservation of erectile function via penile prosthesis placement. The gullwing variation of the technique offers the potential to circumvent these disadvantages. This case describes the gullwing variation of transcorporal AUS placement in a complex patient with a history of abdominopelvic trauma and prior failed AUS placements secondary to urethral erosion. Transcorporal AUS placement in patients with prior urethral compromise has been shown to result in lower revision and erosion rates. The gullwing modification of the technique is a novel variation providing improved circumferential urethral protection and, with the addition of corporal grafting, aims to enable the preservation of the three-dimensional corporal volume necessary for ease of subsequent penile prosthesis implantation. However, studies assessing the long-term functional outcomes and durability of this technique are needed.

Transcroporal Artificial Urinary Sphincter Placement With Closure of Corporal Bodies—A Long-Term Analysis of Functional Outcomes

ObjectivesAn artificial urinary sphincter (AUS) is the gold standard for postoperative stress urinary incontinence (SUI). The transcorporal AUS (TC) placement constitutes the main salvage option in high-risk patients suffering from SUI with fragile urethras. The literature analyzing long-term outcomes with respect to explantation rates, continence, and erectile function is scarce.Methods and PatientsRetrospective data collection was performed in 2011. TC was applied according to a standardized protocol. TC was implanted after bulbar urethroplasty or double-cuff (DC) explantation. After TC placement, the tunica albuginea was closed in order to minimize the risk of postoperative bleedings and erectile dysfunction. Activation was performed 6 weeks postoperatively. Further follow-up (FU) was scheduled 6/24 months postoperatively and every 2 years thereafter. Primary/secondary endpoints were explantation/objective, subjective, and social continence rates. Objective or social continence was defined as the use of 0 pads/day or <2 pads/day, respectively. Thereupon, postoperative bleedings and erectile function were analyzed.ResultsA total of 39 high-risk patients were available for analysis. The median age was 72 years. In total, 84.6%, 10.3%, and 2.6% had a history of radical prostatectomy, TURP, and radical cystectomy, respectively. In total, 61.5% had a history of radiation therapy of the prostate, 41% had a history of urethral surgery, and 95% had a history of double cuff explantation. The median FU was 27 months. Objective, subjective, and social continence were 54.5%, 69.7%, and 78.8%, respectively. The median pad usage was 1 pad/day [1–2.5]. Only one patient suffered from a postoperative hematoma. In total, 15.4% of the patients were able to have an erection preoperatively, compared to 7.7% after TC placement. The estimated mean explantation-free survival of the TC was 83 months in the Kaplan–Meier analysis.ConclusionsTC AUS implantation constitutes a viable salvage approach in high-risk SUI patients with a mean device survival of almost 7 years and high social continence rates of almost 80%. An intraoperative closure of the tunica albuginea after TC placement allows for very low rates of postoperative hematoma and supports postoperative erectile rigidity.

Outcomes of Initial Transcorporal Versus Standard Placement of Artificial Urinary Sphincter in Patients With Prior Radiation.

Objective: This study aimed to evaluate both device and functional outcomes of men who underwent initial artificial urinary sphincter (AUS) placement after pelvic radiation using the transcorporal versus the standard approach.Methods: A retrospective review of patients who underwent first-time AUS placement after pelvic irradiation for prostate cancer was conducted between January 2008 and June 2020. Patients were grouped by transcorporal versus standard device placement. The primary outcomes of interest included major complications (revision or explant surgery) and functional outcomes (pads per day, International Prostate Symptom Score {IPSS}, quality of life {QOL} score).Results: We identified 45 patients who underwent first-time AUS with a history of prior pelvic irradiation for prostate cancer, 27 underwent transcorporal placement and 18 underwent standard placement. Transcorporal AUS placement resulted in a significantly lower number of major complications (p=0.01), explants (p=0.02), and revisions (p=0.04) The transcorporal artificial urinary sphincter group had better postoperative pads per day (p=0.04), IPSS (p<0.01), and IPSS QOL score (p<0.01).Conclusions: Initial transcorporal artificial urinary sphincter placement is a promising technique with lower rates of major complications in patients with a history of prior pelvic radiation and had better functional urinary outcomes.

118 Evaluation of Long Term Complication Rates of Primary Transcorporal Artificial Urinary Sphincter Cuff Placement

Transcorporal artificial urinary sphincter (AUS) cuff placement has been suggested as an option to reduce the risk of urethral erosion in patients with fragile urethras and to potentially reduce the rate of erosions/atrophy in the primary implant patient. Ourprevious published data demonstrated > 50% urethral erosions occur within two years of implantation. Therefore, we sought to evaluate if transcorporal (TC) AUS implantation in the primary, non-fragile urethra implant patient would reduce complication rates compared to primary non-transcorporal (nTC) AUS implant patients with a minimum of 2 years follow-up.

VS-2-4 Synchronous Implantation of an Inflatable Penile Prosthesis and a Transcorporal Artificial Urinary Sphincter

VS-2-4 Synchronous Implantation of an Inflatable Penile Prosthesis and a Transcorporal Artificial Urinary Sphincter

Comparison of 3.5 cm and transcorporal cuffs in high-risk artificial urinary sphincter populations.

The transcorporal (TC) artificial urinary sphincter (AUS) has traditionally been utilized in high-risk patients with urethral atrophy or prior urethral erosion. The 3.5 cm AUS cuff has been developed for use in a similar population. We compared the outcomes of TC AUS and 3.5 cm cuff patients to assess whether the TC approach was protective against urethral complications. We performed a retrospective review for all men who underwent TC AUS and 3.5 cm AUS implantation by a single surgeon from 2007 to 2018 at a tertiary medical center. Demographic and outcomes data were collected and analyzed after database review to evaluate for rates of urethral erosion. Multivariate logistic regression was performed to identify co-morbid factors associated with urethral erosion. In our database of 625 AUS patients, we identified 59 (9%) men with TC AUS and 168 (27%) having a 3.5 cm cuff. Over a median follow-up time of 49 months, 28 (47%) men with TC cuffs developed urethral erosion compared with 25 (15%) men with a 3.5 cm cuff. On univariate analysis, a TC cuff was associated with increased odds of erosion (OR 6.65, 95% CI: 3.20-14.4, P<0.0001) when compared with a 3.5 cm cuff. On multivariate analysis, TC cuffs continued to portend significantly increased odds of cuff erosion. With longer follow up, TC AUS may not be as protective against urethral complications as previously described.

PD32-09 COMPARISON OF 3.5 CM CUFFS AND TRANSCORPORAL CUFFS IN HIGH-RISK ARTIFICIAL URINARY SPHINCTER POPULATIONS

INTRODUCTION AND OBJECTIVES:The transcorporal artificial urinary sphincter (TC AUS) has traditionally been utilized in high-risk patients with urethral atrophy or prior urethral erosion. The 3.5 cm...

PD29-03 MODIFIED TRANSCORPORAL CUFF PLACEMENT IN COMPLEX ARTIFICIAL URINARY SPHINCTER IMPLANTS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2017PD29-03 MODIFIED TRANSCORPORAL CUFF PLACEMENT IN COMPLEX ARTIFICIAL URINARY SPHINCTER IMPLANTS André Cavalcanti, Carlos Felipe Restreppo, Henrique Florindo, Roberto Medeiros, Túlio Rojas, and Neildo Chaves André CavalcantiAndré Cavalcanti More articles by this author , Carlos Felipe RestreppoCarlos Felipe Restreppo More articles by this author , Henrique FlorindoHenrique Florindo More articles by this author , Roberto MedeirosRoberto Medeiros More articles by this author , Túlio RojasTúlio Rojas More articles by this author , and Neildo ChavesNeildo Chaves More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1355AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The transcorporal (TC) artificial urinary sphincter (AUS) cuff placement was first described in 2002 for cases requiring revision for erosion and urethral atrophy. A distal cuff location is often required in patients undergoing artificial urinary sphincter re-implantation after previous erosion or in those requiring revision because of urethral atrophy at the original cuff site. Dissecting the urethra at a more distal site increases the risk of urethral injury and erosion, and often the urethral circumference is so small. A distal cuff placement using TC dissection that leaves corporal tunica albuginea on the dorsal surface of the urethra, allowing for its safer mobilization and adding to its bulk. We present a technical modification on the TC AUS cuff placement based on the use of local tunica albuginea flaps. METHODS The charts of 11 patients submitted to a modified TC cuff placement during a period of 7 years were analysed. The age of the patients ranged from 53 to 81 years (mean of 69 years). The initial approach to the distal urethral and corporal bodies is similar to the classic TC approach. The two bilateral vertical incisions, on each side of the urethra, was modified for a creation of two bilateral tunica albuginea flaps with a rectangular shape. Those flaps are mobilized medially to cover the lateral and ventral portions of the urethra. As on the classic TC approach the corporal septum was opened to create a space to the cuff placement. The tunica albuginea gap created by the flaps mobilization was closed with grafts or treated with glues. A 5.0 cuff was used in 2 cases, a 5.5 cuff in 6 cases and a 6.0 cuff in 3 cases. The modified TC cuff placement was used in 5/11 patients with a history of urethroplasty (4/5 irradiated patients), in 2/11 patients with a history of radiotherapy to treat prostate cancer, in 4/11 patients with a history of previous erosion/infection AUS implants ( 1 or 2 surgeries). RESULTS After a mean follow up of 27,3 months, the rate of implant explantation was 27% (2 associated to cuff erosion and 1 to infection without erosion). 7/11 (63,6%) were using 1 pad or less. A temporary retention was observed in 5/11 patients (45,5%). In 5/11 patients (45,5%) a staged implant was performed. In 3 patients, the cuff was placed on the first procedure and the PRB balloon/cuff on the second procedure. In 2 patients we used a silicone tape was implanted on the first procedure and the AUS implanted on a second procedure. CONCLUSIONS The modified TC AUS cuff placement is an safe and viable technique and could be used as part of the technical armamentarium to deal with complex AUS implants. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e572-e573 Advertisement Copyright & Permissions© 2017MetricsAuthor Information André Cavalcanti More articles by this author Carlos Felipe Restreppo More articles by this author Henrique Florindo More articles by this author Roberto Medeiros More articles by this author Túlio Rojas More articles by this author Neildo Chaves More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

008 Transcorporal Artificial Urinary Sphincter Placement in Patients with Prior Inflatable Penile Prosthesis Utilizing 6-ply Acellular Graft: A Novel Technique with Resolution of Climacturia

008 Transcorporal Artificial Urinary Sphincter Placement in Patients with Prior Inflatable Penile Prosthesis Utilizing 6-ply Acellular Graft: A Novel Technique with Resolution of Climacturia

Transcorporal artificial urinary sphincter in radiated and non - radiated compromised urethra. Assessment with a minimum 2 year follow-up

ABSTRACTPurpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients.Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires.Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients.Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.

69 Transcorporal artificial urinary sphincter implantation for incontinence in high-risk patient: Functional outcomes in a retrospective study

69 Transcorporal artificial urinary sphincter implantation for incontinence in high-risk patient: Functional outcomes in a retrospective study

Transcorporal artificial urinary sphincter implantation as a salvage surgical procedure for challenging cases of male stress urinary incontinence: surgical technique and functional outcomes in a contemporary series

To describe the surgical technique of transcorporal artificial urinary sphincter (AUS) implantation. To assess the efficacy of the AUS on continence and erectile function. A prospective evaluation was conducted between December 2007 and October 2012 at a tertiary referral centre of all male patients treated by transcorporal AUS (AMS800™, AmericanMedicalSystems, Minnetonka, MN, USA) implantation for stress urinary incontinence (SUI) recurrence, after failure of previous anti-incontinence surgery. Functional urinary outcomes were assessed according to daily pad use, the Urinary Symptom Profile questionnaire, and International Consultation on Incontinence Questionnaire - Short-Form. Erectile function was evaluated using the five-item International Index of Erectile Function (IIEF-5) questionnaire and patient satisfaction was assessed by Patient Global Impression of Improvement questionnaire. Data were collected by telephone interview. A total of 23 patients were included. Their mean (sd; range) age was 70 (7; 60-85) years. Of these, 18 patients had urethral atrophy and/or erosion after placement of AUS (11 patients), male sling (four patients) or both (three patients), and five patients had severe urethral atrophy after pelvic radiation therapy. The implantation of the AUS with transcorporal cuff placement was successful in all patients, with no peri-operative complications. Follow-up data over 1 year were available for 17 patients. After a median (sd; range) follow-up of 20 (15; 2-59) months, eight patients were perfectly dry (no pad use and no symptoms), five achieved social continence (less than one pad/day), and four still had SUI (required two or more pads/day). Among six patients who had good preoperative erectile function and were sexually active, four had no decrease in their IIEF-5 score. Transcorporal AUS cuff placement is a useful alternative for challenging cases of male SUI after failure of previous surgical treatment, urethral atrophy or erosion. Erectile function can be maintained despite dissection of the corporal body.

Long-Term Device Outcomes of Artificial Urinary Sphincter Reimplantation Following Prior Explantation for Erosion or Infection

We evaluated clinical outcomes in patients treated with artificial urinary sphincter reimplantation after artificial urinary sphincter explantation for erosion or infection. We identified 704 consecutive artificial urinary sphincter implantation procedures performed at our institution from 1998 to 2012, including 497 (71%) as primary implantation and 138 (20%) as revision surgery for device malfunction. A total of 69 patients (10%) had undergone at least 1 prior artificial urinary sphincter explantation secondary to urethral erosion and/or device infection, of whom 36 (52%) were treated with 2 to 5 prior reimplantation procedures. Patient followup was performed through office examination, or written or telephone correspondence. Patients treated with artificial urinary sphincter reimplantation had a median age of 78 years (IQR 72, 80) and a median followup of 34 months (IQR 5, 61). Artificial urinary sphincter reimplantation was done a median of 9 months (IQR 6, 13) after explantation. Patients treated with reimplantation after erosion or infection were more likely to require repeat explantation than those with primary implantation (13 of 69 or 19% vs 32 of 497 or 6.4%, p = 0.002). However, when evaluating repeat procedures, the 5-year device survival rate after reimplantation due to erosion or infection vs primary implantation was 68% vs 76% (p = 0.38). Our findings suggest that artificial urinary sphincter reimplantation after explantation for urethral erosion and/or device infection is associated with an increased rate of recurrent erosion/infection requiring repeat explantation. However, in appropriately selected and counseled patients clinically acceptable long-term device use can be achieved.

Impact of 3.5 cm Artificial Urinary Sphincter Cuff on Primary and Revision Surgery for Male Stress Urinary Incontinence

We report our initial clinical experience with the new 3.5 cm artificial urinary sphincter cuff. We reviewed the records of all men who underwent artificial urinary sphincter placement done by a single surgeon since September 2009. A perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement with a redesigned measuring tape. Clinical factors and cuff sizes were analyzed. During the 14-month study period 45 of 67 patients (67%) with an artificial urinary sphincter received the 3.5 cm cuff with no difference between primary and revision surgery (73% vs 58%, p = 0.29). Transcorporal cuff placement was reserved for 8 select patients (12%) after prior artificial urinary sphincter cuff erosion or complex urethroplasty. A tandem cuff artificial urinary sphincter was not used. Erectile dysfunction (89% vs 77%, p = 0.28) and prior radiation (47% vs 27%, p = 0.12) were more common in men who received a 3.5 vs a 4.0 cm or greater cuff. A similar proportion of men with a 3.5 cm vs a larger cuff (4 of 45 or 9% vs 2 of 22 or 9%) required explantation for infection and/or erosion. At our center the 3.5 cm cuff has become the predominant size used for primary and revision artificial urinary sphincter placement. Liberal use of the 3.5 cm cuff has simplified and improved artificial urinary sphincter placement without additional morbidity.

1348 HYPERCONTINENCE AND CUFF EROSION AFTER ARTIFICIAL URINARY SPHINCTER INSERTION: A COMPARISON OF CUFF SIZES AND PLACEMENT TECHNIQUES

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence—Evaluation & Therapy1 Apr 20111348 HYPERCONTINENCE AND CUFF EROSION AFTER ARTIFICIAL URINARY SPHINCTER INSERTION: A COMPARISON OF CUFF SIZES AND PLACEMENT TECHNIQUES Paul Smith, Steven Hudak, and Allen Morey Paul SmithPaul Smith Dallas, TX More articles by this author , Steven HudakSteven Hudak Dallas, TX More articles by this author , and Allen MoreyAllen Morey Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1169AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have noted that a small percentage of men who undergo placement of an artificial urinary sphincter (AUS) for stress urinary incontinence (SUI) develop transient post-operative urinary retention. Some of these patients become “hypercontinent” requiring prolonged urethral catheterization and/or placement of a suprapubic catheter (SPT). In this study, we evaluated the AUS cuff sizes and techniques associated with hypercontinence. METHODS We analyzed the outcomes of AUS cases performed by a single surgeon from 2007–2010. All patients underwent cuff placement in the most proximal bulb via a perineal incision. Cases were analyzed in three groups according to cuff size–3.5 cm, ≥4.0 cm, or transcorporal cuff (TC). Newer techniques developed for men with periurethral atrophy (3.5 cm cuff and TC cuff) were compared against the traditional cuff size group (≥4 cm). Outcomes relating to urinary retention, SPT placement, and cuff erosion were analyzed. RESULTS Among 138 patients who underwent AUS placement from 2007–2010, 108 cases met inclusion criteria—those placed via a penoscrotal approach or with incomplete follow up data were excluded: 41 men received a 3.5 cm cuff, 46 received a ≥4 cm cuff, and 21 received a TC cuff (all ≥4 cm). TC patients had a significantly higher rate of urinary retention requiring SPT placement compared to the ≥4.0 cm group [5/21 (24%) vs. 2/46 (4%), p = 0.03] and a slightly higher rate than the 3.5 cm group [5/41 (12%), p = 0.3]. The 3.5 cm, ≥4 cm, and TC groups all exhibited similar rates of cuff erosion [3/41 (7%), 2/46 (4%), and 1/21 (5%), p>0.05]. Cuff erosions were much more common in hypercontinent men compared to those without hypercontinence [4/21 (19%) vs 2/87 (2%), p = 0.01], especially in the 3.5 cm and TC group. No significant differences were found between these groups in the rates of diabetes, erectile dysfunction, previous radiation therapy, or previous SUI surgical intervention. CONCLUSIONS Transcorporal AUS placement is associated with a higher rate of postoperative urinary retention and need for suprapubic tube placement compared to traditional 4.0 cm cuff placement. Hypercontinence is a potential risk factor for cuff erosion, likely due to recurrent transurethral instrumentation or prolonged catheterization. The risk of urinary retention requiring further instrumentation and/or SPT placement should be discussed with candidates for TC AUS. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e538-e539 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Smith Dallas, TX More articles by this author Steven Hudak Dallas, TX More articles by this author Allen Morey Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Editorial Comment

The incidence of severe postprostatectomy incontinence (PPI) requiring an artificial urinary sphincter (AUS) is ≥5%. 1 Flynn B.J. Peterson A.C. Webster G.D. Evaluation and management of intrinsic sphincter deficiency after radical prostatectomy. AUA Update Series. 2007; (Lesson 15.1): 149-160 Google Scholar Many of these men survive prostate cancer and live into their 80s. These patients are especially at risk of AUS erosion owing to the comorbid conditions that commonly exist in this age group, including hypertension, coronary artery disease, radiotherapy, and previous AUS revision. 2 Raj G.V. Peterson A.C. Webster G.D. Outcomes following erosions of the artificial urinary sphincter. J Urol. 2006; 175: 2186-2190 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar Consequently, in referral centers for men with PPI, it is not uncommon to see a man in his 80s with coronary artery disease, previous radiotherapy, and severe PPI after AUS erosion. The management options include nonoperative treatment with sanitary pads, a condom catheter, or a penile clamp or surgical therapy such as a sling or an AUS. Comparison of Outcomes for Adjustable Bulbourethral Male Sling and Artificial Urinary Sphincter After Previous Artificial Urinary Sphincter ErosionUrologyVol. 73Issue 6PreviewTo compare the outcomes of the adjustable bulbourethral male sling and artificial urinary sphincter (AUS) in patients with recurrent postprostatectomy incontinence after previous AUS erosion. Full-Text PDF ReplyUrologyVol. 73Issue 6PreviewRecurrent incontinence after removal of an artificial urinary sphincter (AUS) is a devastating condition associated with important deteriorations in quality of life, especially for patients who have previously experienced a dry period. It has been emphasized that transcorporal AUS reimplantation can be a viable treatment option for these patients.1-3 However, it can be sometimes difficult or impossible to make a decision regarding the application of AUS replacement because of the increase in secondary erosion rates and/or the existence of some risk factors related to patient characteristics, as mentioned in the Editorial Comment. Full-Text PDF