To compare long term outcomes and erosion rates of 3.5 cm artificial urinary sphincter (AUS) cuffs versus larger cuffs among men with stress urinary incontinence (SUI), with and without a history of pelvic radiation.
We reviewed the records of all men who underwent AUS placement by a single surgeon between September 2009 and June 2017 at our tertiary urban medical center. A uniform perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement. Patients were stratified by cuff size and radiation status, and patient demographics and surgical outcomes were analyzed. Cases of AUS revision in which a new cuff was not placed were excluded. Success was defined as patient-reported use of ≤1 pad per day.
Among 410 cases included in the analysis, the 3.5 cm cuff was used in 166 (40.5%), while 244 (59.5%) received 4.0 cm or larger cuffs. Over a median follow-up of 50 months, AUS cuff erosion was observed in 44 patients at a rate nearly identical in the 3.5 cm cuff (10.8%, 18/166) and the ≥4 cm cuff groups (10.7%, 26/244, p=0.7). On multivariate logistic regression, clinical factors associated with AUS cuff erosion included history of pelvic radiation, prior AUS cuff erosion, prior urethroplasty, and history of inflatable penile prosthesis (IPP) placement. Patient demographics were similar between the two cuff size groups, including age, BMI, comorbidities, smoking history, radiation history, prior AUS, and prior IPP. Continence rates were high among all AUS patients, with similar success in both groups (82% for 3.5 cm, 90% for 4+ cm, p=0.1).
After eight years of experience and extended follow-up, the outcomes of the 3.5 cm AUS cuff appear to be similar to ≥4 cm cuffs with respect to efficacy and rates of urethral erosion. Radiated patients have a higher risk of cuff erosion regardless of cuff size. This article is protected by copyright. All rights reserved.
BJU international. 2018 Jul 14 [Epub ahead of print]
Maxim J McKibben, Nabeel Shakir, Joceline S Fuchs, Jeremy M Scott, Allen F Morey
Urology University of Texas Southwestern Medical Center Dallas Texas, United States.