Long-term lower urinary tract sequelae following AUS cuff erosion

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.