Is Risk of Artificial Urethral Sphincter Cuff Erosion Higher in Patients with Penile Prosthesis?. Issue 9 (1st September 2016)

• Record Type: Journal Article
• Authors: Sundaram, Varun; Cordon, Billy H.; Hofer, Matthias D.; Morey, Allen F.
• Is Part Of: Journal of sexual medicine. Volume 13:Issue 9(2016)
• Page Start: 1432
• Page End: 1437
• Publication Date: 2016-09-01
• Subjects: Artificial Urethral Sphincter -- Penile Prosthesis -- Erosion -- Stress Urinary Incontinence; Sexual disorders -- Periodicals; Sex -- Periodicals; Sexual health -- Periodicals; 616.69005
• DOI: 10.1016/j.jsxm.2016.06.013
• Languages: English
• ISSNs: 1743-6095

Abstract

ABSTRACT: Introduction: Frequently encountered morbidities after prostatectomy include stress urinary incontinence and erectile dysfunction. Patients with severe disease may undergo placement of both a penile prosthesis (PP) and an artificial urethral sphincter (AUS). Aim: We hypothesized that concomitant PP may promote AUS cuff erosion by impaired corporal blood flow and/or direct pressure on the cuff. The aim of this study was to compare the rate of AUS cuff erosion in patients with and without a PP. Methods: We reviewed 366 AUS operations at our tertiary center between 2007 and 2015 with a mean follow-up of 41 months (range 6–104). Included in the analysis were first-time AUS cuff erosions. Patients with recurrent erosions, AUS revisions, and iatrogenic erosions were excluded. In a separate analysis, we analyzed AUS explantations for all causes. Cohorts were compared by demographic information, preoperative characteristics, and rates of erosion and explantation. Main Outcome Measures: Erosion confirmed by cystourethroscopy and explantation of the AUS for all causes. Results: Among 366 AUS surgeries at a mean follow-up of 41 months, there were 248 (67.8%) AUS alone cases compared to 118 (32.2%) AUS and PP cases (AUS/PP). Sixty-two patients met exclusion criteria for first-time cuff erosion. Among 304 evaluable AUS patients, we found a significantly higher rate of erosion in the AUS/PP group (11/95, 11.6%) compared to the AUS alone group (9/209, 4.3%, P = .037). When examining explantations for all causes in the entire cohort (n = 366), we observed a significantly higher rate of device removal, (20/118, 17%) in the AUS/PP group compared to the AUS group (23/248, 9.2%, P = .044). Conclusion: AUS/PP patients appear to have a higher risk of AUS cuff erosion and explantation compared to men with AUS alone.