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Long-term lower urinary tract sequelae following AUS cuff erosion.

Nathan A Chertack1, Kelly M Caldwell1, Gregory A Joice1

  • 1Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Neurourology and Urodynamics
|September 24, 2021
PubMed
Summary

Lower urinary tract complications (LUTC) are frequent following artificial urinary sphincter (AUS) explantation due to erosion. Larger cuff erosions increase the risk of permanent urinary diversion (UD), impacting patient outcomes.

Keywords:
artificial urinary sphincteroutcomesstress urinary incontinenceurethral cuff erosion

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Area of Science:

  • Urology
  • Reconstructive Surgery
  • Medical Device Complications

Background:

  • Artificial urinary sphincter (AUS) explantation due to cuff erosion can lead to significant lower urinary tract complications (LUTC).
  • Acute reconstruction of erosion defects is a critical step in managing these complications.
  • Understanding the impact of erosion severity on outcomes is crucial for patient management.

Purpose of the Study:

  • To evaluate the incidence of LUTC and the need for urinary diversion (UD) after AUS explantation and acute cuff defect reconstruction.
  • To assess the influence of erosion severity on LUTC, UD, and subsequent AUS reimplantation rates.

Main Methods:

  • Retrospective analysis of patients undergoing in-situ urethroplasty (ISU) for AUS cuff erosion (June 2007-December 2020).
  • Outcomes assessed: LUTC (stricture, diverticulum, fistula), AUS reimplantation, and UD.
  • Subanalysis based on erosion severity (small [<33%] vs. large [≥33%] circumferential defect).

Main Results:

  • 40 patients underwent ISU for AUS cuff erosion; median age 76 years, median erosion 46%.
  • Overall LUTC rate was 30%, with 35% requiring permanent UD.
  • Small erosions correlated with better LUTC-free and UD-free survival but not AUS reimplantation rates.

Conclusions:

  • Lower urinary tract complications are common after AUS cuff erosion, often necessitating permanent urinary diversion.
  • Patients with larger urethral cuff erosions face a higher likelihood and earlier onset of permanent urinary diversion.