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Low Serum Testosterone Level Predisposes to Artificial Urinary Sphincter Cuff Erosion

      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.
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      Linked Article

      • Reply by the Authors
        UrologyVol. 101
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          Important 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.
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      • Re: Hofner et al.: Low Serum Testosterone Level Predisposes to Artificial Urinary Sphincter Cuff Erosion (Urology 2016;97:245-249)
        UrologyVol. 101
        • Preview
          We 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.
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