To describe and compare artificial urinary sphincter (AUS) cuff erosion sites and their associated clinical implications.
We retrospectively reviewed men who presented with AUS erosion treated by a single surgeon between 2007 and 2019 at a tertiary medical center. Transcorporal (TC) indications included complications of prior anti-incontinence procedures and prior urethral reconstruction. Location of AUS cuff erosion defects were assessed by cystoscopy prior to device explantation; findings were stratified into patients who had TC versus standard (ST) AUS placement.
Out of 723 AUS cases in 611 patients, we identified 54 (7.5%) cuff erosions. Erosion developed in 15/82 (18.3%) cases of TC AUS and 39/641 (6.1%) cases of ST AUS (p<0.05). AUS cuff erosions occurred predominantly ventrally in both groups (66.7% for TC and 79.5% for ST AUS, p=0.4) followed by lateral urethral location (33.3% TC and 20.5% ST, p=0.3). Dorsal erosions were rare in both groups (20% TC and 5.1% ST, p=0.1). History of AUS and previous erosion were associated with TC AUS erosion. History of radiotherapy, prior urethroplasty, hypogonadism, and urethral cuff size were similar between groups.
AUS cuff erosions appear to occur ventrally and laterally in most patients regardless of cuff placement. Dorsal erosions were the least common in both groups. The protective effect of TC AUS could not be conclusively demonstrated.
The Journal of urology. 2020 May 27 [Epub ahead of print]
Nicolas M Ortiz, Avery R Wolfe, Adam S Baumgarten, Ellen E Ward, Maia E VanDyke, Steven J Hudak, Allen F Morey
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.