Sorena Keihani1, Jason C Chandrapal2, Andrew C Peterson2, Joshua A Broghammer3, Nathan Chertack4, Sean P Elliott5, Keith F Rourke6, Nejd F Alsikafi7, Jill C Buckley8, Benjamin N Breyer9, Thomas G Smith10, Bryan B Voelzke11, Lee C Zhao12, William O Brant13, Jeremy B Myers13. 1. Division of Urology, University of Utah, Salt Lake City, UT. Electronic address: sorena.keihani@hsc.utah.edu. 2. Division of Urology, Duke University Medical Center, Durham, NC. 3. Department of Urology, University of Kansas Medical Center, Kansas City, KS. 4. Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH. 5. Department of Urology, University of Minnesota, Minneapolis, MN. 6. Division of Urology, University of Alberta, Edmonton, AB, Canada. 7. Uropartners, Gurnee, IL. 8. Department of Urology, University of California San Diego, San Diego, CA. 9. Department of Urology, University of California-San Francisco, San Francisco, CA. 10. Department of Urology, Baylor College of Medicine, Houston, TX. 11. Department of Urology, University of Washington Medical Center, Seattle, WA. 12. New York University School of Medicine, New York, NY. 13. Division of Urology, University of Utah, Salt Lake City, UT.
Abstract
OBJECTIVE: To evaluate the success of urethroplasty for urethral strictures arising after erosion of an artificial urinary sphincter (AUS) and rates of subsequent AUS replacement. PATIENTS AND METHODS: From 2009-2016, we identified patients from the Trauma and Urologic Reconstruction Network of Surgeons and several other centers. We included patients with urethral strictures arising from AUS erosion undergoing urethroplasty with or without subsequent AUS replacement. We retrospectively reviewed patient demographics, history, stricture characteristics, and outcomes. Variables in patients with and without complications after AUS replacement were compared using chi-square test, independent samples t test, and Mann-Whitney U test when appropriate. RESULTS: Thirty-one men were identified with the inclusion criteria. Radical prostatectomy was the etiology of incontinence in 87% of the patients, and 29% had radiation therapy. Anastomotic (28) and buccal graft substitution (3) urethroplasty were performed. Follow-up cystoscopy was done in 28 patients (median 4.5 months, interquartile range [IQR]: 3-8) showing no urethral stricture recurrences. Median overall follow-up was 22.0 months (IQR: 15-38). In 27 men (87%), AUS was replaced at median of 6.0 months (IQR: 4-7) after urethroplasty. In 25 patients with >3 months of follow-up after AUS replacement, urethral complications requiring AUS revision or removal occurred in 9 patients (36%) and included subcuff atrophy (3) and erosion (6). Mean length of stricture was higher in patients who developed a complication after urethroplasty and AUS replacement (2.2 vs. 1.5 cm, P = .04). CONCLUSION: In patients with urethral stricture after AUS erosion, urethroplasty is successful. However, AUS replacement after urethroplasty has a high erosion rate even in the short-term.
OBJECTIVE: To evaluate the success of urethroplasty for urethral strictures arising after erosion of an artificial urinary sphincter (AUS) and rates of subsequent AUS replacement. PATIENTS AND METHODS: From 2009-2016, we identified patients from the Trauma and Urologic Reconstruction Network of Surgeons and several other centers. We included patients with urethral strictures arising from AUS erosion undergoing urethroplasty with or without subsequent AUS replacement. We retrospectively reviewed patient demographics, history, stricture characteristics, and outcomes. Variables in patients with and without complications after AUS replacement were compared using chi-square test, independent samples t test, and Mann-Whitney U test when appropriate. RESULTS: Thirty-one men were identified with the inclusion criteria. Radical prostatectomy was the etiology of incontinence in 87% of the patients, and 29% had radiation therapy. Anastomotic (28) and buccal graft substitution (3) urethroplasty were performed. Follow-up cystoscopy was done in 28 patients (median 4.5 months, interquartile range [IQR]: 3-8) showing no urethral stricture recurrences. Median overall follow-up was 22.0 months (IQR: 15-38). In 27 men (87%), AUS was replaced at median of 6.0 months (IQR: 4-7) after urethroplasty. In 25 patients with >3 months of follow-up after AUS replacement, urethral complications requiring AUS revision or removal occurred in 9 patients (36%) and included subcuff atrophy (3) and erosion (6). Mean length of stricture was higher in patients who developed a complication after urethroplasty and AUS replacement (2.2 vs. 1.5 cm, P = .04). CONCLUSION: In patients with urethral stricture after AUS erosion, urethroplasty is successful. However, AUS replacement after urethroplasty has a high erosion rate even in the short-term.
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