Long-term Artificial Urinary Sphincter Outcomes Following a Prior Rectourethral Fistula Repair

To determine the long-term outcomes of artificial urinary sphincter (AUS) implantation following a successful rectourethral fistula (RUF) repair.

Between January 1, 2006 and January 1, 2012, a total of 26 patients underwent successful repair of an RUF. Stress urinary incontinence was treated in 6 patients (23%) with implantation of an AUS. Preoperative and postoperative evaluation included demographic variables, voiding diaries, 24-hour pad weight, urodynamic characteristics, operative time, estimated blood loss, complication rates, follow-up time, and cuff selection.

All 6 patients underwent successful RUF repair using a perineal approach. Mean age was 64.3 years (range 58-74). Mean follow-up after repair was 51.5 months (range 34-64). RUF etiology included radical prostatectomy (4), brachytherapy + external beam radiotherapy (1), and cryotherapy + external beam radiotherapy (1). The median time between RUF repair and AUS placement was 12 months (range 2-41). No intraoperative complications occurred during AUS implantation. The average operative time was 61.8 minutes with an estimated blood loss of 24 mL. The initial cuff size selected was 4.0 or 4.5 cm, and no patient required transcorporal cuff placement. Pad use was reported as ≤1 pad per day in all 6 patients at the initial 3-month follow-up. Median follow-up after AUS placement was 43.5 months (5-55). No patient required revision or removal for mechanical complications, infection, or erosion. No patient had recurrence of their previously repaired RUF or new-onset fecal incontinence.

Patients who require placement of an AUS after an RUF repair seem to fare just as well as patients who undergo primary AUS implantation with no increased rate of complications postoperatively.