Does indigo carmine prevent early artificial urinary sphincter cuff erosion?

Urethral erosion following artificial urinary sphincter (AUS) placement is hypothesized to be secondary to unrecognized intra-operative urethral injury. Intra-urethral indigo carmine solution (ICS), a blue dye, following urethral mobilization should identify intra-operative urethrotomy and prevent early post-operative cuff erosion.

Retrospective review was completed of all men undergoing AUS (AMS 800 device) insertion between January 2000 and January 2005 for post prostatectomy stress incontinence at one institution. Operative reports were examined for use of intra-operative injection of ICS as well as documentation of urethral injury. Post-operative course was reviewed for evidence of early cuff erosion. All patients were followed a minimum of 6 months post-operatively.

Seventy-eight men underwent AUS placement during the investigative period. Forty-one men received intra-operative ICS injection following urethral mobilization and 37 men did not. ICS identified one intra-operative urethral injury. No urethral injuries were noted in the non-injection group. The ICS group suffered 3 (7.3%) early urethral erosions; the control group had one early urethral erosion (2.7%).

Intra-operative ICS use is easy, safe, and able to identify urethral injury. However, its use did not preclude the incidence of early cuff erosion. This may postulate the existence of early urethral cuff erosion as a separate entity not dependent on intra-operative urethrotomy.