Dorsolateral fibro-muscular tissue preservation during artificial urinary sphincter cuff placement is associated with low infection and erosion rates

To present a modified technique in artificial urinary sphincter (AUS) placement that is associated with low rates of erosion and infection in a high-risk population.

After IRB approval, we identified patients who underwent primary AUS placement using the modified technique between January 2007 and November 2015. Our modification consists of preserving the dorsal fibro-muscular tissue surrounding the bulbar urethra and horizontally transecting the ventral bulbospongiosus muscle during urethral cuff placement. Preoperative variables such as radiation therapy and bladder neck contractures were recorded. Efficacy and complications including infections, erosions, and reoperations were recorded at follow-up.

The new technique was used on 208 patients: 40% had a history of radiation therapy including 15% salvage radical prostatectomy; 26% had previous bladder neck contractures. No patients developed infection. Overall erosion occurred in 6 (2.9%) patients and spontaneous erosions occurred in 2 (0.9%) during the study period. Twenty-one patients underwent reoperation for device failure. The probability of reoperation for any reason was 7% (95% CI 4%, 12%) at 1 year. The 12-month social continence rate was 74% (95% CI 67%, 81%).

Preservation of dorsolateral fibro-muscular tissue for AUS placement is an effective means to achieve low risk for erosions. Our modified technique is safe with low infection and erosion rates while maintaining good functional outcomes despite a high-risk population. This article is protected by copyright. All rights reserved.

BJU international. 2018 Jul 03 [Epub ahead of print]

Felix Cheung, Ali Fathollahi, Emily Vertosick, Thomas R Jarvis, Darren Katz, Jaspreet S Sandhu

Memorial Sloan Kettering Cancer Center., New York Medical College., Prince of Wales Clinical School., Men's Health Melbourne.