To evaluate the functional and surgical impact of CIC protocols in men with a bulbar AUS in place. Stress urinary incontinence (SUI) and poor bladder emptying are both sequelae of prostate cancer treatment, though there is sparse data to guide concomitant management.
The safety of intermittent catheterization (CIC) in men with an artificial urinary sphincter (AUS) at the bulbar urethra remains unclear.
We performed a retrospective review of all bulbar urethral AUS procedures at our institution. Inclusion criteria were patients with a history of prostate cancer treatment, AUS placement for SUI, and a history of CIC before and/or after AUS placement. All eligible cases were retrospectively reviewed. Surgical and continence outcomes were analyzed.
57 patients were identified with a history of CIC and AUS placement under the care of two surgeons. Eighteen continued to perform CIC or first initiated CIC after AUS placement and 39 discontinued CIC protocol prior to AUS placement. The incidence of erosion was no different amongst patients who continued or discontinued CIC after AUS placement (17.9% vs 22.2%, p=0.79). There was no difference in future AUS removal or replacement (56.4% vs 44.4%, p=0.41). Both groups experienced improvement in urinary incontinence after placement of an AUS.
Bulbar AUS placement in the setting of continuous intermittent catheterization can be considered in patients who are not surgical candidates for definitive treatment of their outlet obstruction.
Urology. 2022 Nov 01 [Epub ahead of print]
Kevin Krughoff, Austin J Livingston, Brian Inouye, Andrew C Peterson, Aaron C Lentz
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address: ., Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA., Division of Urology, Department of Surgery, Albany Medical College, Albany, NY, USA.