Login to Access Video or Poster Abstract: MP46-08
Sources of Funding: none

Introduction

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.

Funding

none