Abstract: PD29-02
Sources of Funding: This project was supported in part by a generous reconstructive urology educational grant from American Medical Systems Inc., Minnetonka, MN.

Introduction

Urethral stricture can result after AUS cuff erosion. There is limited data describing the success of urethroplasty and the rate of AUS reimplantation in these patients. We hypothesized that urethroplasty and AUS reimplantation was feasible in most men.

Methods

From 2009-2016, we identified patients from Trauma and Urologic Reconstruction Network of Surgeons (TURNS) database, as well as the Cleveland Clinic, Duke University, and University of Alberta. We included patients with a history of urethral stricture arising from AUS erosion who underwent urethroplasty ± subsequent AUS reimplantation. Information was gathered on demographics, initial AUS placement, stricture and urethroplasty specifics, AUS reimplantation, and outcomes. In results analysis we included men with follow up of > 3 months.

Results

31 men were identified. Mean age was 73.2 y (SD: 7.0). Radical prostatectomy was the etiology of incontinence in 87%, with 33% having radiation therapy. Prior to urethroplasty, patients had a median of 3 (range: 2-9) urethral operations. Mean duration of initial AUS was 43.4 months (SD: 39.9, range: 1-144) prior to erosion. Mean stricture length was 1.7 cm (SD: 0.8, range 0.5-4.5) found within the bulbar urethra in all cases (9 proximal, 16 middle, 6 distal). Anastomotic (28) and buccal graft substitution (3) urethroplasty were performed. 3/28 patients who had a urethrogram post-operatively had contrast extravasation; all resolved with observation. Post-operative complications included: wound infection (3), and myocardial infarction (1). 29 men had follow up > 3 months. Follow up cystoscopy was performed in 28 patients at a median of 4.5 months (range 2-42) and showed no recurrences. Overall mean follow up was 28.2 months (SD: 16.2, range 6.5-71). Two men had stricture recurrence, but these occurred after AUS reimplantation and repeat erosion. _x000D_ _x000D_ In 27 men (87%), AUS was replaced at mean of 6.2 months (SD: 2.6, range 3-13) after urethroplasty, with either transcorporal placement (18) or standard technique (9). 25 men had follow-up > 3 months after AUS (mean 23.1 months, SD: 15.1, range 4-57); operative complications occurred in 11/25 patients (44%) and included: pump migration (2), sub-cuff atrophy (3), and erosion (6). The 19 men with AUS remaining reported ≤1 pad per day leakage. _x000D_

Conclusions

In patients with urethral stricture after AUS erosion, urethroplasty is very successful and AUS reimplantation rates are high. However, AUS reimplantation after urethroplasty has a high erosion rate even in the short-term.

Funding

This project was supported in part by a generous reconstructive urology educational grant from American Medical Systems Inc., Minnetonka, MN.