Login to Access Video or Poster Abstract: MP46-05
Sources of Funding: None

Introduction

The artificial urinary sphincter (AUS) remains the gold standard for the surgical treatment of male stress urinary incontinence. Device failure or revision can be due to multiple etiologies including device erosion, infection, mechanical malfunction, and urethral atrophy. Despite the known risk, to date, few studies have evaluated factors that predispose patients to urethral atrophy. Here, we sought to identify preoperative and perioperative risk factors associated with urethral atrophy in men undergoing primary AUS placement.

Methods

From 1987 to 2013, a total of 1,068 men underwent primary AUS placement at our institution. Multiple clinical and surgical variables were evaluated for a potential association with revision for atrophy. Those found to be associated with atrophy were further evaluated on multivariable analysis including competing risks.

Results

With a median follow-up of 4.2 years (IQR 1.3-8.1), 89 men (8.3%) experienced urethral atrophy requiring reoperation for recurrent SUI. Median time to urethral atrophy was 4.5 years (IQR 1.9-7.6). On univariate analysis, only smaller cuff size (4.0-cm versus 4.5-cm; HR 3.1, p=0.04) was associated with an increased rate of urethral atrophy. Notably, patient age at the time of surgery (p=0.62), BMI (0.22), and smoking status (p=1.00) were not associated with a risk of atrophy. On multivariable analysis smaller urethral cuff size remained significant for increased risk of revision for urethral atrophy (HR 2.8, 95% CI 1.1-7.1; p=0.01).

Conclusions

Revision surgery for urethral atrophy occurs in approximately 8% of men undergoing primary AUS placement. Utilization of a smaller AUS cuff size appears to be an independent factor associated with increased rate of urethral atrophy.

Funding

None