Risk factors for erosion of artificial urinary sphincters: A multicenter prospective study - Abstract

OBJECTIVE: To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection.

METHODS: A prospective outcome analysis was performed on 386 patients treated with AUS placement from April 2009 to December 2012 at 8 institutions with at least 3 months of follow-up. Charts were analyzed for preoperative risk factors and postoperative complications requiring explantation.

RESULTS: Approximately 50% of patients were considered high risk. High risk was defined as patients having undergone radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS. A total of 31 explantations (8.03%) were performed during the follow-up period. Overall explantation rates were higher in those with prior radiation and prior UroLume. Men with prior AUS infection or erosion also had a trend for higher rates of subsequent explantation. Men receiving 3.5-cm cuffs had significantly higher explantation rates than those receiving larger cuffs.

CONCLUSION: This outcomes study confirms that urethral risk factors, including radiation history, prior AUS erosion, and a history of urethral stent placement, increase the risk of AUS explantation in short-term follow-up.

Written by:
Brant WO, Erickson BA, Elliott SP, Powell C, Alsikafi N, McClung C, Myers JB, Voelzke BB, Smith Iii TG, Broghammer JA.   Are you the author?
Department of Surgery, Division of Urology, Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT; Department of Urology, University of Iowa, Iowa City, IA; Department of Urology, University of Minnesota, Minneapolis, MN; Department of Urology, University of Kansas Medical Center, Kansas City, KS; Department of Urology, Loyola University, Chicago, IL; Ohio State University, Columbus, OH; Department of Urology, University of Washington, Seattle, WA; Scott Department of Urology, Baylor College of Medicine, Houston, TX.  

Reference: Urology. 2014 Aug 8. pii: S0090-4295(14)00605-0.
doi: 10.1016/j.urology.2014.05.043

PubMed Abstract
PMID: 25109562

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