AUTHOR=Kuhlencord Katharina , Dahlem Roland , Vetterlein Malte W. , Abrams-Pompe Raisa S. , Maurer Valentin , Meyer Christian P. , Riechardt Silke , Fisch Margit , Ludwig Tim A. , Marks Phillip 

TITLE=Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.829517

DOI=10.3389/fsurg.2022.829517

ISSN=2296-875X

ABSTRACT=Objectives: To describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyse success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation.
Patients and Methods: Data of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009-2015. In case of cuff erosion AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation/mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for three weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad-test, uroflowmetry, post-voiding residual urine (PVR) and radiography. Primary endpoint was urethral stricture rate.
Results: Out of 235 patients after AUS implantation 24 (10,2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation 2 patients (8,3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17ml/s without suspicion of urethral stricture. Median time to re-implantation was 4 months (IQR 3-4).
Conclusion: We observed a considerably low stricture formation and could not proof an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion.