Artificial urinary sphincter placement and survival in compromised urethras, "Beyond the Abstract," by Thomas W. Gaither, BS and Benjamin N. Breyer, MD

BERKELEY, CA (UroToday.com) - AUS placement in patients with a compromised urethra from prior AUS placement, radiation, or urethroplasty was associated with a statistically significant risk of failure. Infection and erosion were responsible for the majority of failures in the compromised group. Failure from infection or erosion was also more common in urethroplasty patients than those with a history of radiation or prior AUS placement.[1]

During a urethroplasty, extensive mobilization and transection of the urethra can severely compromise blood flow. It has been hypothesized that compromised blood flow, as found in diabetes or sickle cell anemia, predisposes individuals to infections via localized areas of hypoxia and acidosis, which can favor growth of certain pathogens.[2] Therefore, it seems reasonable that compromised blood flow from a urethroplasty may predispose individuals for infection and erosion of future AUS placement. Interestingly, transcorporal AUS placement correlates with lower rates of infection than the standard AUS placement in high-risk patients, although larger sample sizes are required for a more definitive association.[3] Our results coincide with this, as transcorporally placed cuffs did not have a significantly higher rate of failure in patients with a compromised urethra. Recently, Linder et al. have shown no significant difference in 5-year device survival in men who underwent transcorporal versus nontranscorporal placement for prior explantation for erosion or infection.[4] These results, along with ours and others,[5, 6] provide more evidence for this approach in such high-risk patients.

References:

  1. McGeady JB, McAninch JW, Truesdale MD, Blaschko SD, Kenfield S, and Breyer BN. Artificial urinary sphincter placement and survival in compromised urethras—a comparison of virgin, radiated, and re-operative cases. Journal of Urology. Accepted June 30, 2014.
  2. Booth C, Inusa B, Obaro S. Infections in sickle cell disease: a review. International Journal of Infectious Diseases. 2010; 14: e2-e12.
  3. Aaronson DS, Elliot SP, and McAninch JW. Transcorporal artificial urinary sphincter placement for incontinence in high-risk patients after treatment of prostate cancer. Reconstructive Urology. 2008; 72: 825-827.
  4. Linder BJ, de Cogain M, Elliot DS. Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection. Journal of Urology. 2014; 191: 734-738.
  5. Magera JS Jr, Elliot DS. Tandem transcorporal artificial urinary sphincter cuff salvage technique: surgical description and results. Journal of Urology. 2007; 177: 1015.
  6. Guralnic ML, Miller E, Toh KL et al. Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. Journal of Urology. 2002; 167: 2075.

Written by:
Thomas W. Gaither, BS and Benjamin N. Breyer, MD* as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

*Assistant Professor
Department of Urology
University of California, San Francisco
Chief of Urology, San Francisco General Hospital
Director, UCSF Male Genitourinary Reconstruction and Trauma Surgery Fellowship

Artificial urinary sphincter placement and survival in compromised urethras - A comparison of virgin, radiated, and re-operative cases - Abstract

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