Martin S Gross1, Joshua A Broghammer2, Melissa R Kaufman3, Douglas F Milam3, William O Brant4, Mario A Cleves5, Travis W Dum2, Christopher McClung6, LeRoy A Jones7, Jeffrey D Brady8, Michael B Pryor9, Gerard D Henry10. 1. Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: martin.s.gross@gmail.com. 2. University of Kansas Medical Center, Kansas City, KS. 3. Vanderbilt University Medical Center, Nashville, TN. 4. University of Utah Hospital, Salt Lake City, UT. 5. University of Arkansas for Medical Sciences, Little Rock, AR. 6. Central Ohio Urology Group, Gahanna, OH. 7. Urology San Antonio, San Antonio, TX. 8. Florida Urology Associates, Orlando, FL. 9. Urology Center of Spartanburg, Spartanburg, SC. 10. Regional Urology, Shreveport, LA.
Abstract
OBJECTIVE: To evaluate the influence of both repair type and degree of cuff erosion on postoperative urethral stricture rate. Sparse literature exists regarding patient outcomes after artificial urinary sphincter (AUS) cuff erosion. Surgeons from 6 high-volume male continence centers compiled a comprehensive database of post-erosion patients to examine outcomes. MATERIALS AND METHODS: This retrospective multi-institution study included 80 patients treated for AUS cuff erosions. Seventy-eight patients had specific information regarding post-cuff erosion urethral strictures. Erosion patients were categorized into 1 of 3 repair types at the time of explant surgery: catheter only, single-layer capsule-to-capsule repair (urethrorrhaphy), and formal urethroplasty. Operative notes and available medical records were extensively reviewed to collect study data. RESULTS: Twenty-five of 78 patients manifested a urethral stricture after AUS cuff erosion (32%). More strictures occurred among patients who underwent urethrorrhaphy (40% vs 29% for catheter only and 14% for urethroplasty). Stricture rates did not vary significantly by repair type (P = .2). Strictures occurred significantly more frequently in patients with complete cuff erosions (58%) as compared to partial erosions (25%, P = .037). A trend was detected regarding increased percentage of erosion correlating with increased stricture rate, but this did not reach statistical significance (P = .057). Partially eroded patients were more likely to undergo urethrorrhaphy repair (60%, P = .002). CONCLUSION: Urethral stricture was more likely to occur after complete cuff erosion as opposed to partial erosion in this multicenter retrospective population. Repair type, whether catheter only, urethrorrhaphy, or formal urethroplasty, did not appear to influence postoperative stricture rate.
OBJECTIVE: To evaluate the influence of both repair type and degree of cuff erosion on postoperative urethral stricture rate. Sparse literature exists regarding patient outcomes after artificial urinary sphincter (AUS) cuff erosion. Surgeons from 6 high-volume male continence centers compiled a comprehensive database of post-erosion patients to examine outcomes. MATERIALS AND METHODS: This retrospective multi-institution study included 80 patients treated for AUS cuff erosions. Seventy-eight patients had specific information regarding post-cuff erosion urethral strictures. Erosion patients were categorized into 1 of 3 repair types at the time of explant surgery: catheter only, single-layer capsule-to-capsule repair (urethrorrhaphy), and formal urethroplasty. Operative notes and available medical records were extensively reviewed to collect study data. RESULTS: Twenty-five of 78 patients manifested a urethral stricture after AUS cuff erosion (32%). More strictures occurred among patients who underwent urethrorrhaphy (40% vs 29% for catheter only and 14% for urethroplasty). Stricture rates did not vary significantly by repair type (P = .2). Strictures occurred significantly more frequently in patients with complete cuff erosions (58%) as compared to partial erosions (25%, P = .037). A trend was detected regarding increased percentage of erosion correlating with increased stricture rate, but this did not reach statistical significance (P = .057). Partially eroded patients were more likely to undergo urethrorrhaphy repair (60%, P = .002). CONCLUSION: Urethral stricture was more likely to occur after complete cuff erosion as opposed to partial erosion in this multicenter retrospective population. Repair type, whether catheter only, urethrorrhaphy, or formal urethroplasty, did not appear to influence postoperative stricture rate.
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: Katharina Kuhlencord; Roland Dahlem; Malte W Vetterlein; Raisa S Abrams-Pompe; Valentin Maurer; Christian P Meyer; Silke Riechardt; Margit Fisch; Tim A Ludwig; Phillip Marks Journal: Front Surg Date: 2022-02-09