Does indigo carmine prevent early artificial urinary sphincter cuff erosion?

Area of Science:

• Urology
• Surgical Innovation
• Medical Device Safety

Background:

• Urethral erosion after artificial urinary sphincter (AUS) placement is often linked to unrecognized intraoperative urethral injury.
• Intraurethral indigo carmine solution (ICS) is proposed to identify urethral damage during surgery, potentially preventing early cuff erosion.

Purpose of the Study:

• To evaluate the efficacy of intraoperative indigo carmine solution (ICS) in identifying urethral injury during artificial urinary sphincter (AUS) placement.
• To determine if ICS use reduces the incidence of early post-operative cuff erosion.

Main Methods:

• Retrospective review of 78 patients undergoing AMS 800 AUS insertion for post-prostatectomy stress incontinence.
• Analysis of operative reports for ICS use, documented urethral injury, and post-operative cuff erosion.
• Minimum 6-month follow-up for all patients.

Main Results:

• Forty-one patients received intraoperative ICS, identifying one urethral injury. Thirty-seven patients did not receive ICS, with no urethral injuries noted.
• The ICS group experienced 3 (7.3%) early urethral erosions, while the control group had 1 (2.7%) early erosion.

Conclusions:

• Intraoperative ICS is a safe and easy method for identifying urethral injuries during AUS placement.
• The use of ICS did not significantly decrease the incidence of early cuff erosion.
• Early urethral cuff erosion may occur independently of intraoperative urethral injury.