Indications and Outcomes for Intermittent Catheterization following Bulbar AUS Cuff Placement

Published:October 31, 2022DOI:



      To evaluate the functional and surgical impact of CIC protocols in men with a bulbar AUS in place. Stress urinary incontinence (SUI) and poor bladder emptying are both sequelae of prostate cancer treatment, though there is sparse data to guide concomitant management. The safety of intermittent catheterization (CIC) in men with an artificial urinary sphincter (AUS) at the bulbar urethra remains unclear.


      We performed a retrospective review of all bulbar urethral AUS procedures at our institution. Inclusion criteria were patients with a history of prostate cancer treatment, AUS placement for SUI, and a history of CIC before and/or after AUS placement. All eligible cases were retrospectively reviewed. Surgical and continence outcomes were analyzed.


      A total of 57 patients were identified with a history of CIC and AUS placement under the care of two surgeons. Eighteen continued to perform CIC or first initiated CIC after AUS placement and 39 discontinued CIC prior to AUS placement. The incidence of erosion was no different amongst patients who continued or discontinued CIC after AUS placement (17.9% vs 22.2%, P = .79). There was no difference in future AUS removal or replacement (56.4% vs 44.4%, P = .41). Both groups experienced improvement in urinary incontinence after placement of an AUS.


      Bulbar AUS placement in the setting of continuous intermittent catheterization can be considered in patients who are not surgical candidates for definitive treatment of their outlet obstruction.


      SUI (Stress Urinary Incontinence), CIC (Clean Intermittent Catheterization), AUS (Artificial Urinary Sphincter), DU (Detrusor Underactivity), BOO (Bladder Outlet Obstruction), BNC (Bladder Neck Contracture)
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        • Litwin MS
        • Melmed GY
        • Nakazon T.
        Life after radical prostatectomy: a longitudinal study.
        J Urol. 2001; 166: 587-592
        • Goluboff ET
        • Saidi JA
        • Mazer S
        • et al.
        Urinary continence after radical prostatectomy: the Columbia experience.
        J Urol. 1998; 159: 1276-1280
        • Wilson LC
        • Gilling PJ.
        Post-prostatectomy urinary incontinence: a review of surgical treatment options.
        BJU Int. 2011; 107: 7-10
        • Parsons JK
        • Marschke P
        • Maples P
        • Walsh PC.
        Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy.
        Urology. 2004; 64: 987-990
        • Stanford JL
        • Feng Z
        • Hamilton AS
        • et al.
        Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer Outcomes study.
        JAMA. 2000; 283: 354-360
        • Bedretdinova D
        • Fritel X
        • Zins M
        • Ringa V.
        The effect of urinary incontinence on health-related quality of life: is it similar in men and women?.
        Urology. 2016; 91: 83-89
        • Mottet N
        • Boyer C
        • Chartier-Kastler E
        • Ben Naoum K
        • Richard F
        • Costa P
        Artificial urinary sphincter AMS 800 for urinary incontinence after radical prostatectomy: the French experience.
        Urol Int. 1998; 60: 25-29
        • Gomha MA
        • Boone TB.
        Artificial urinary sphincter for postprostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis.
        J Urol. 2002; 167: 591-596
        • Trigo Rocha F
        • Gomes CM
        • Mitre AI
        • Arap S
        • Srougi M
        A prospective study evaluating the efficacy of the artificial sphincter AMS 800 for the treatment of postradical prostatectomy urinary incontinence and the correlation between preoperative urodynamic and surgical outcomes.
        Urology. 2008; 71: 85-89
        • Gousse AE
        • Madjar S
        • Lambert MM
        • Fishman IJ.
        Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: long-term subjective results.
        J Urol. 2001; 166: 1755-1758
        • Lai HH
        • Hsu EI
        • Teh BS
        • Butler EB
        • Boone TB.
        13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine.
        J Urol. 2007; 177: 1021-1025
        • Kim PH
        • Pinheiro LC
        • Atoria CL
        • Eastham JA
        • Sandhu JS
        • Elkin EB.
        Trends in the use of incontinence procedures after radical prostatectomy: a population based analysis.
        J Urol. 2013; 189: 602-628
        • Sandhu JS
        • Breyer B
        • Comiter C
        • et al.
        Incontinence after prostate treatment: AUA/SUFU guideline.
        J Urol. 2019; 202: 369-378
        • Coyne KS
        • Zhou Z
        • Thompson C
        • Versi E.
        The impact on health-related quality of life of stress, urge and mixed urinary incontinence.
        BJU Int. 2003; 92: 731-735
        • Coyne KS
        • Kvasz M
        • Ireland AM
        • Milsom I
        • Kopp ZS
        • Chapple CR.
        Urinary incontinence and its relationship to mental health and health-related quality of life in men and women in Sweden, the United Kingdom, and the United States.
        Eur Urol. 2012; 61: 88-95
        • Elliott SP
        • Meng MV
        • Elkin EP
        • et al.
        Incidence of urethral stricture after primary treatment for prostate cancer: data From CaPSURE.
        J Urol. 2007; 178: 529-534
        • Seideman CA
        • Zhao LC
        • Hudak SJ
        • Mierzwiak J
        • Adibi M
        • Morey AF.
        Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion?.
        Urology. 2013; 82: 943-946
        • Di Benedetto P.
        Clean intermittent self-catheterization in neuro-urology.
        Eur J Phys Rehabil Med. 2011; 47: 651-659
        • Barrett DMF
        Incontinence, intermittent self-catheterization and the artificial genitourinary sphincter.
        J Urol. 1984; 132: 268-269
        • Kahokehr AA
        • Peterson AC
        • Lentz AC.
        Posterior urethral stenosis after prostate cancer treatment: contemporary options for definitive management.
        Transl Androl Urol. 2018; 7: 580-592
        • Lubahn JD
        • Zhao LC
        • Scott JF
        • et al.
        Poor quality of life in patients with urethral stricture treated with intermittent self-dilation.
        J Urol. 2014; 191: 143-147
        • Granieri MA
        • Weinberg AC
        • Sun JY
        • Stifelman MD
        • Zhao LC.
        Robotic Y-V p[lasty for recalcitrant bladder neck contracture.
        Urology. 2018; 117: 163-165
        • Musch M
        • Hohenhorst JL
        • Vogel A
        • Loewen H
        • Krege S
        • Kroepfl D.
        Robot-assisted laparoscopic Y-V plasty in 12 patients with refractory bladder neck contracture.
        J Robot Surg. 2018; 12: 139-145
        • Spiess PE
        • Capolicchio JP
        • Kiruluta G
        • Salle JP
        • Berardinucci G
        • Corcos J.
        Is an artificial sphincter the best choice for incontinent boys with Spina Bifida? Review of our long term experience with the AS-800 artificial sphincter.
        Can J Urol. 2002; 9: 1486-1491
        • Castera R
        • Podesta ML
        • Ruarte A
        • Herrera M
        • Medel R.
        10-Year experience with artificial urinary sphincter in children and adolescents.
        J Urol. 2001; 165: 2373-2376
        • Agarwal DK
        • Linder BJ
        • Elliott DS.
        Artificial urinary sphincter urethral erosions: Temporal patterns, management, and incidence of preventable erosions.
        Indian J Urol. 2017; 33: 26-29
        • McKibben MJ
        • Shakir N
        • Fuchs JS
        • Scott JM
        • Morey AF.
        Erosion rates of 3.5-cm artificial urinary sphincter cuffs are similar to larger cuffs.
        BJU Int. 2019; 123: 335-341
        • Sundaram V
        • Cordon BH
        • Hofer MD
        • Morey AF.
        Is risk of artificial urethral sphincter cuff erosion higher in patients with penile prosthesis?.
        J Sex Med. 2016; 13: 1432-1437
        • Raj GV
        • Peterson AC
        • Toh KL
        • Webster GD.
        Outcomes following revisions and secondary implantation of the artificial urinary sphincter.
        J Urol. 2005; 173: 1242-1245