Objective
To evaluate the success of urethroplasty for urethral strictures arising after erosion
of an artificial urinary sphincter (AUS) and rates of subsequent AUS replacement.
Patients and Methods
From 2009-2016, we identified patients from the Trauma and Urologic Reconstruction
Network of Surgeons and several other centers. We included patients with urethral
strictures arising from AUS erosion undergoing urethroplasty with or without subsequent
AUS replacement. We retrospectively reviewed patient demographics, history, stricture
characteristics, and outcomes. Variables in patients with and without complications
after AUS replacement were compared using chi-square test, independent samples t test, and Mann-Whitney U test when appropriate.
Results
Thirty-one men were identified with the inclusion criteria. Radical prostatectomy
was the etiology of incontinence in 87% of the patients, and 29% had radiation therapy.
Anastomotic (28) and buccal graft substitution (3) urethroplasty were performed. Follow-up
cystoscopy was done in 28 patients (median 4.5 months, interquartile range [IQR]:
3-8) showing no urethral stricture recurrences. Median overall follow-up was 22.0
months (IQR: 15-38). In 27 men (87%), AUS was replaced at median of 6.0 months (IQR:
4-7) after urethroplasty. In 25 patients with >3 months of follow-up after AUS replacement,
urethral complications requiring AUS revision or removal occurred in 9 patients (36%)
and included subcuff atrophy (3) and erosion (6). Mean length of stricture was higher
in patients who developed a complication after urethroplasty and AUS replacement (2.2
vs. 1.5 cm, P = .04).
Conclusion
In patients with urethral stricture after AUS erosion, urethroplasty is successful.
However, AUS replacement after urethroplasty has a high erosion rate even in the short-term.
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
- Artificial urinary sphincter for post-prostatectomy incontinence: a review.Int J Urol. 2014; 21: 536-543
- Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan.J Urol. 2008; 179: 1912-1916
- Outcomes following revisions and secondary implantation of the artificial urinary sphincter.J Urol. 2005; 173: 1242-1245
- Long-term outcomes after primary failures of artificial urinary sphincter implantation.Urology. 2012; 79: 922-928
- 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine.J Urol. 2007; 177: 1021-1025
- Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study.Urology. 2014; 84: 934-938
- Outcomes following erosions of the artificial urinary sphincter.J Urol. 2006; 175 (discussion 2190): 2186-2190
- Foley or fix: a comparative analysis of reparative procedures at the time of explantation of artificial urinary sphincter for cuff erosion.Urology. 2016; 90: 173-178
- Immediate urethral repair during explantation prevents stricture formation after artificial urinary sphincter cuff erosion.J Urol. 2014; 192: 442-446
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Validation of a combined comorbidity index.J Clin Epidemiol. 1994; 47: 1245-1251
- Transcorporal artificial urinary sphincter placement for incontinence in high-risk patients after treatment of prostate cancer.Urology. 2008; 72: 825-827
- Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion?.Urology. 2013; 82: 943-946
- Urethral stricture outcomes after artificial urinary sphincter cuff erosion: results from a multicenter retrospective analysis.Urology. 2017; 104: 198-203
- Male urethral stricture: American Urological Association guideline.J Urol. 2017; 197: 182-190
- Urethrotomy has a much lower success rate than previously reported.J Urol. 2010; 183: 1859-1862
- What is the most cost-effective treatment for 1 to 2-cm bulbar urethral strictures: societal approach using decision analysis.Urology. 2006; 67: 889-893
- Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture.J Urol. 2005; 173: 1206-1210
- Cost-effective strategies for the management and treatment of urethral stricture disease.Urol Clin North Am. 2017; 44: 11-17
- High regional variation in urethroplasty in the United States.J Urol. 2015; 193: 179-183
- Patterns of management of urethral stricture disease in the Veterans Affairs system.Urology. 2011; 78: 454-458
- Straddle injuries to the bulbar urethra: management and outcomes in 78 patients.J Urol. 2004; 171: 722-725
- In situ urethroplasty after artificial urinary sphincter cuff erosion.Transl Androl Urol. 2015; 4: 56-59
- Complex artificial urinary sphincter revision and reimplantation cases—how do they fare compared to virgin cases?.J Urol. 2012; 187: 951-955
- Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection.J Urol. 2014; 191: 734-738
- Comparison of outcomes for adjustable bulbourethral male sling and artificial urinary sphincter after previous artificial urinary sphincter erosion.Urology. 2009; 73: 1363-1367
- Two-stage transperineal management of posterior urethral strictures or bladder neck contractures associated with urinary incontinence after prostate surgery and endoscopic treatment failures.Eur Urol. 2007; 52: 1499-1504
- Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases.J Urol. 2014; 192: 1756-1761
- Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy.J Urol. 2002; 167 (discussion 2079): 2075-2078
- Transcorporal artificial urinary sphincter implantation as a salvage surgical procedure for challenging cases of male stress urinary incontinence: surgical technique and functional outcomes in a contemporary series.BJU Int. 2013; 112: 1163-1168
Article info
Publication history
Published online: June 14, 2017
Accepted:
May 2,
2017
Received:
March 7,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This work was supported in part by a generous reconstructive urology educational grant from Boston Scientific. Boston Scientific had no role in study concept, design, data acquisition and analysis, or manuscript drafting and revision.
Meeting Presentation: This report was presented at the 112th Meeting of the American Urological Association, Boston, MA, May 12-16, 2017.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
