Varun Sundaram1, Billy H Cordon1, Matthias D Hofer1, Allen F Morey2. 1. Department of Urology, University of Texas Southwestern, Dallas, TX, USA. 2. Department of Urology, University of Texas Southwestern, Dallas, TX, USA. Electronic address: allen.morey@utsouthwestern.edu.
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.
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.
Authors: Roger K Khouri; Nicolas M Ortiz; Benjamin M Dropkin; Gregory A Joice; Adam S Baumgarten; Allen F Morey; Steven J Hudak Journal: Curr Urol Rep Date: 2021-03-29 Impact factor: 3.092
Authors: Linley Diao; Samantha W Nealon; Gianpaolo P Carpinito; Shervin Badkhshan; Avery R Wolfe; Benjamin M Dropkin; Sarah C Sanders; Steven J Hudak; Allen F Morey Journal: Int Braz J Urol Date: 2022 Jul-Aug Impact factor: 3.050