Reported rates of urethral stricture development after artificial urinary sphincter (AUS) erosion are highly variable. We hypothesized that the risk of stricture is commensurate with the degree of erosion.
We reviewed our prospectively maintained QI database for all patients with AUS erosion from 2011 to 2022. The incidence of post-operative stricture development was compared to the severity of erosion using a graded scale: 1) <25% circumference 2) 25-50% circumference 3) >50% and <100% circumference 4) 100% circumference. From 862 AUS surgeries, 102 erosion cases were identified, and 63 with documented erosion severity were included for analysis. Additional analysis was performed on 28 cases without documented erosion severity for validation.
Within the main cohort, urethral stricture developed in 22 (34.9%) patients. The incidence of stricture did not vary by grade of erosion (P = .73) and was not significantly higher in men with grade 4 erosion versus lower grade erosions (32.7% vs 50.0%, P = .34). Radiation exposure was associated with a 41.1% higher incidence of stricture (P < .01) and nearly every stricture occurred in the setting of prior radiation (21 of 22; 95.5%). In the validation group, 10 (35.7%) developed stricture, most with a history of radiation (8 of 10; 80%). Overall, 29 of 32 (90.6%) cases of stricture involved a history of radiation.
AUS erosion does not lead to urethral stricture formation in most cases and is not associated with degree of erosion. Those who develop strictures nearly always have a history of pelvic radiation.
The Journal of urology. 2023 Mar 22 [Epub ahead of print]
Kevin Krughoff, Thomas Dvergsten, Jordan R Foreman, Andrew C Peterson
Oregon Urology Institute, Springfield, Oregon., Duke University Hospital, Durham, North Carolina.