Hypothesis / aims of study
The artificial urinary sphincter (AUS) is still the standard treatment of male stress urinary incontinence (SUI) caused by sphincter deficiency and offers good outcomes and patient’s satisfaction. As expected with any other prosthetic device, complications including mechanical failure, infection or erosion are reported. The most studies recommend an explanation of the entire device in case of erosion(1,2,3). However, in case of isolated urethral erosion with negative urinary tract infection (UTI) and if no device malfunction is identified, it can be appropriate to remove only the cuff and to preserve the tubes.
The aim of this retrospective, single center trial was to report on the impacts of an isolated explantation and possible replacement of the urethral cuff after erosion.
Study design, materials and methods
We evaluated clinical outcomes in patients with artificial urinary sphincter after the explantation of the urethral cuff and preserving the remaining components. All cases had sterile urine cultures. We included 13 patients between January 2016 and December 2017. The median age of the patients at the time of the surgery was 74.7 year (mean 75yr). After preparation of the urethra, the tubes were clipped, the cuff was removed, and the previously separated parts of the tubes were left in situ. A transurethral catheter was left in place for 4-6 weeks to allow the urethra to heal. The cuff explantation was performed in 17 cases (3 patients with recurrent erosions). The remaining components of the device were sealed using the AMS 800 Repair Kit. The explantation of the cuff was performed in an average time of 45.4 months (median=21) after initial AUS-implantation. All the explanted components were completely unremarkable. There were no intra- or postoperative complications and the mean operation time was 27.9 minutes.
Interpretation of results
By isolated explanation of the cuff after urethral erosion, we preserved 92% of the remaining devices. Additionally, this procedure enables the surgeon to keep the operation time as short as possible, this can be requested in case of patients in poor general condition. A transcoporal cuff placement is associated with a lower rate of recurrent erosion. In this cohort both patients with distal transcorporal cuff placement had no recurrent erosion. Moreover, we were able to replace the urethral cuff in a second procedure in more than 80% of the cases and all the devices were in situ at the time of data collection with no sign of infection or mechanical failure.
For reasons mentioned above, salvage surgical procedures for artificial urinary sphincter should be performed with preservation the components, whenever it is possible.