Indications and Outcomes for Intermittent Catheterization following Bulbar AUS Cuff Placement

The management of recalcitrant bladder neck contractures remains a challenge, with little consensus despite dozens of case series, expert opinions and single-institution algorithms. The challenge takes on an extra order of magnitude when the patient is also struggling with urinary incontinence, as bladder neck contractures and their associated methods for management are historically considered contraindications to artificial urinary sphincter (AUS) placement.

Certainly, every reasonable attempt should be made to avoid AUS erosion, however the surgical dogma governing this situation can leave men suffering months to years with severe incontinence before treatment with an AUS. Following one patient’s report of successfully self-initiating CIC after undergoing AUS placement, the option was considered for a number of patients down the road. We have not found that those who continued clean intermittent catheterization (CIC) with an AUS in place were at any higher risk for erosion, in many cases even after years of daily CIC. With proper patient selection, this may expand treatment options for men with complex voiding dysfunction and incontinence with concomitant obstruction.

Written by: Kevin Krughoff, MD, Oregon Urology Institute, Springfield, OR

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