Objective
To examine the association between decreased serum testosterone levels and artificial
urinary sphincter (AUS) cuff erosion.
Materials and Methods
We evaluated serum testosterone levels in 53 consecutive patients. Low testosterone
was defined as <280 ng/dL and found in 30/53 patients (56.6%). Chi-square and Student
t tests, Kaplan-Meier analysis, binary logistic regression, and Cox regression analysis
were used to determine statistical significance.
Results
Nearly all men with AUS cuff erosions had low serum testosterone (18/20, 90.0%) compared
to those without erosions (12/33, 36.4%, P < .001). Mean time to erosion was 1.70 years (0.83-6.86); mean follow-up was 2.76
years (0.34-7.92). Low testosterone had a hazard ratio of 7.15 for erosion in a Cox
regression analysis (95% confidence interval 1.64-31.17, P = .009) and Kaplan-Meier analysis demonstrated decreased erosion-free follow-up (log-rank
P = .002). Low testosterone was the sole independent risk factor for erosion in a multivariable
model including coronary artery disease and radiation (odds ratio 15.78; 95% confidence
interval 2.77-89.92, P = .002). Notably, history of prior AUS, radiation, androgen ablation therapy, or
concomitant penile implant did not confound risk of cuff erosion in men with low testosterone
levels.
Conclusion
Men with low testosterone levels are at a significantly higher risk to experience
AUS cuff erosion. Appropriate counseling before AUS implantation is warranted and
it is unclear whether testosterone resupplementation will mitigate this risk.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence.Eur Urol. 2013; 63: 681-689
- Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at mayo clinic.Urology. 2015; 86: 602-607
- Indications for revision of artificial urinary sphincter and modifiable risk factors for device-related morbidity.Neurourol Urodyn. 2013; 32: 63-65
- Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study.Urology. 2014; 84: 934-938
- Long-term outcomes after primary failures of artificial urinary sphincter implantation.Urology. 2012; 79: 922-928
- Outcomes following revisions and secondary implantation of the artificial urinary sphincter.J Urol. 2005; 173: 1242-1245
- Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less.Urology. 2006; 68: 1263-1267
- Exogenous testosterone and estrogen affect bladder tissue contractility and histomorphology differently in rat ovariectomy model.J Sex Med. 2011; 8: 1626-1637
- Effects of steroid hormones on morphology and vascular endothelial growth factor expression in female bladder.Urology. 2009; 73: 1210-1217
- 3.5 cm artificial urinary sphincter cuff erosion occurs predominantly in irradiated patients.J Urol. 2015; 193: 593-597
- Artificial urinary sphincter outcomes in the “fragile urethra”.Urology. 2015; 86: 618-624
- Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction.BJU Int. 2002; 89: 364-368
- Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion?.Urology. 2013; 82: 943-946
- Hypogonadism following prostate-bed radiation therapy for prostate carcinoma.Cancer. 2001; 91: 1889-1895
- Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging.J Clin Endocrinol Metab. 2001; 86: 724-731
- Testosterone replacement therapy following the diagnosis of prostate cancer: outcomes and utilization trends.J Sex Med. 2014; 11: 1063-1070
- Testosterone therapy in men with untreated prostate cancer.J Urol. 2011; 185: 1256-1260
- Testosterone replacement therapy in the setting of prostate cancer treated with radiation.Int J Impot Res. 2013; 25: 24-28
- Loss of circadian rhythmicity in blood testosterone levels with aging in normal men.J Clin Endocrinol Metab. 1983; 56: 1278-1281
Article Info
Publication History
Published online: July 20, 2016
Accepted:
April 30,
2016
Received:
March 25,
2016
Footnotes
Financial Disclosure: Dr. Allen F. Morey receives honoraria for being a guest lecturer and meeting participant for American Medical Systems and Coloplast Corp. The remaining authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Reply by the AuthorsUrologyVol. 101
- PreviewImportant distinctions exist between the current study and that of Sundaram et al.1 First, patient cohorts were fundamentally different. In the current study, we prospectively evaluated testosterone levels in a subset of our artificial urinary sphincter (AUS) population—those who returned to the clinic during a 3-month routine follow-up and those with concerns for AUS erosion. In contrast, the cohort in Sundaram et al contained 366 AUS patients including 73 patients with testosterone levels available—these levels were retrospectively extracted from the patient records.
- Full-Text
- Preview
- Re: Hofner et al.: Low Serum Testosterone Level Predisposes to Artificial Urinary Sphincter Cuff Erosion (Urology 2016;97:245-249)UrologyVol. 101
- PreviewWe read this article with great interest and appreciate the work of the authors. The authors aimed to investigate the potential association between decreased serum testosterone levels and artificial urinary sphincter (AUS) cuff erosion in patients who underwent radical prostatectomy or primary radiation for prostate cancer.1 Their findings revealed that low testosterone level was the sole independent risk factor for cuff erosion. Interestingly, prior AUS history, radiotherapy, androgen ablation treatment, and concomitant penile prosthesis implantation did not confound risk of cuff erosion in men with decreased testosterone values.
- Full-Text
- Preview
