Dataset Information

Delayed management of artificial urinary sphincter cuff erosion: a case series.

ABSTRACT:

Background

The artificial urinary sphincter (AUS) has been used to treat post-prostatectomy incontinence in men for decades with excellent outcomes and low complication rates. A successful AUS placement can dramatically improve the quality of life in men with stress urinary incontinence. Consequently, complications in this population can be devastating for the patient. One of the most troublesome complications is cuff erosion, which necessitates explantation of the device and dooms a man to recurrent incontinence. While the device can be replaced, device replacements are fraught with high erosion rates. Furthermore, it is not uncommon for men undergoing AUS placement to have multiple medical comorbidities that make urgent surgery for explantation unideal. Nonetheless, men with cellulitis and significant symptoms must undergo removal of an eroded AUS. There is little to no literature published on the timing or need for device removal in the man who has an asymptomatic erosion.

Case description

We report a case series of five men undergoing delayed or no explantation of an asymptomatic cuff erosion. All five men were asymptomatic at the time of presentation and underwent a delayed explant or no explant. No man required urgent device explant while the erosion was present.

Conclusions

Urgent device explantation may not be necessary in the asymptomatic AUS cuff erosion, and further study may be able to elucidate men who can avoid removal of cuff erosion when no symptoms are present.

SUBMITTER: Shumaker LA

PROVIDER: S-EPMC10251094 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Delayed management of artificial urinary sphincter cuff erosion: a case series.

Shumaker Luke A LA Compher Tyler R TR Selph John P JP

Translational andrology and urology 20230508 5

<h4>Background</h4>The artificial urinary sphincter (AUS) has been used to treat post-prostatectomy incontinence in men for decades with excellent outcomes and low complication rates. A successful AUS placement can dramatically improve the quality of life in men with stress urinary incontinence. Consequently, complications in this population can be devastating for the patient. One of the most troublesome complications is cuff erosion, which necessitates explantation of the device and dooms a man ...[more]

PMID: 37305620

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Project description:BackgroundCuff erosion following artificial urinary sphincter (AUS) implantation, can have devastating downstream sequelae. As there is a paucity of literature regarding outcomes following AUS removal due to erosion, we aim to report rates of urinary fistulae (UF) and urethral stricture (US) complications after AUS removal in patients presenting with AUS cuff erosion.MethodsA retrospective chart review was performed on all patients who underwent AUS explant due to erosion from July 2009 to December 2020 at University of Southern California/Norris Comprehensive Cancer Center. All patients were managed with a standardized approach that involves prompt device explantation, suture urethrorraphy, and continual urethral catheter drainage. Patient demographic data, hypothesized cause of erosion, and post-operative outcomes were collated.ResultsA total of 98 patients underwent AUS removal due to erosion. No intraoperative complications occurred during AUS explantation. The median age at AUS erosion was 79.4 years old [interquartile range (IQR), 72.7-83.1 years] with 45 (45.9%) of age 80 or greater. The median follow-up after AUS removal was 19.8 months (IQR, 7.0-49.2 months). Of these patients, 86 (87.8%) had a "fragile" urethra (history of pelvic radiotherapy, urethroplasty, or prior AUS failure or erosion) with 28 (28.6%) having two or more risk factors prior to AUS erosion at our institution. Fifty-three (54.1%) patients had history of pelvic radiation, 14 (14.3%) had a previous erosion, 6 (6.1%) had previous cuff relocation unrelated to erosion, and 6 (6.1%) had dual cuffs, 18 (18.4%) had a previous history of a posterior transecting urethroplasty, and 2 (2.0%) had a previous anterior urethroplasty. Of the 98 patients, 6 (6.1%) developed a de novo urethrocutaneous fistula (UCF) with median time to fistula resolution of 3.8 months. A total of 18 (18.4%) patients developed a US after AUS explantation, while 7 (7.1%) of those patients required urethral dilation and 2 required urethroplasty (2.0%). Notably, in patients with a penile prosthesis (PP) in situ (n=28), no infectious or erosive complications arose subsequent to AUS removal and catheterization. Prior erosions and posterior urethroplasty were found to be significantly associated with the development of UCF and US.ConclusionsIn a contemporary cohort of patients presenting with AUS cuff erosion, rates of UCF and US are low. Due to the increassed risk of these complications after prior erosions, strategies to prevent initial erosion events should be further explored.

Project description:Background and objectiveIn a patient who complains of both stress urinary incontinence (SUI) and erectile dysfunction (ED), prosthetic surgery with a urinary continence device and penile prosthesis implant can offer a definitive solution to address both problems. The AMS 800 artificial urinary sphincter (AUS) device is considered the standard of care to restore SUI while the inflatable penile prosthesis (IPP) device is thought to be superior to a malleable prosthesis to provide a more natural penile erection with higher patient satisfaction rates. The following article explores the current understanding of AMS 800 AUS surgery and IPP device in treating males with concurrent SUI and ED as well as evaluates the advantages and disadvantages of concurrent synchronous dual vs. delayed or staged device implantation.MethodsThe available literature on AUS and IPP implantation was reviewed on PubMed and Embase databases between 1 January 2000 and 1 December 2022. This narrative review evaluates relevant key features pertaining to prosthetic surgery with an emphasis on arguments for concurrent synchronous dual vs. delayed sequential surgery for AUS and IPP devices. Additionally, this paper provides a brief surgical description of the techniques and potential complications relating to both prosthetic procedures.Key content and findingsWhile a great deal is known about the excellent outcomes of both AUS and IPP implantation, there is limited literature published on the outcomes of dual AUS and IPP surgery. The decision to proceed with concurrent synchronous dual vs. delayed sequential two-stage implants is likely determined by the patient's preference, the surgeon's expertise, and the availability of prostheses. In either situation, patients should be counselled regarding the advantages and disadvantages of undergoing synchronous concurrent vs. delayed sequential implants and associated surgical challenges are likely dependent on the patient's anatomy and the surgeon's preference.ConclusionsFor carefully selected patients with SUI and ED, dual implantation of AUS and IPP provides a definitive treatment to address both conditions at the same time. Patients should be counselled regarding the advantages and disadvantages of synchronous concurrent vs. sequentially delayed implants while technical considerations regarding the sequence of prosthetic device surgery are likely dependent on the patient's factors and the surgeon's preference and surgical expertise.

Project description:Background and objectiveStress urinary incontinence (SUI) is the involuntary loss of urine affecting 1-3% of the male population. To manage leakage, patients may try a plethora of penile clamps. and may even consider artificial urinary sphincters (AUS) or sling implantation. We aimed to synthesize the evolution of the modern clamp, AUS, and sling through a comprehensive patent search.MethodsPatents were found through the databases of United States Patent and Trademark Office (USPTO), GooglePatents, and the World Intellectual Property Office Patentscope, covering patents published through January 6, 2024.Key content and findingsWe found 30 different patents (10 clamps, 13 AUS, and 7 slings), including the patents pertaining to the functionalities and design of five commercially available penile clamps, the American Medical System 800 (AMS 800), the InVance, AdVance, AdVance XP, and Virtue Slings. The clamps, spanning back to 1938 with Bard Cunningham's clamp, have undergone significant refinements. For example, inventors such as Edson S. Outwin and Juan F. V. Wiesner, have modified the location of the primary pressure point. Accessibility has also improved with inventors, such as Gerald French and John W. Timmons, fastening the clamps with Velcro®, as opposed to the screw and ratchet catch closing mechanism, as in Cunningham's clamp. Similarly, the AUS has greatly evolved since Foley's 1947 "Artificial Sphincter and Method", which was the primary AUS precedent to Mark Polyak's AUS invention, which covered the essential elements and functionalities, such as the incorporation of a balloon reservoir, for the AMS 800. In addressing AUS limitations, inventors such as David W. Anderson and Louisa Thomas have created non-hydraulic AUSs. Likewise, the male sling has seen an evolution in the method of securement, from the use of fixed bone anchors in the InVance sling to the transobturator route used in the AdVance XP, avoiding bone complications. Additionally, innovation in sling adjustment of urethral compression allows for adjustable urethral elevation and distal compression respectively. Recent patents have claimed technological integration for clamps, AUS, and slings, especially concerning automation.ConclusionsOverall, patents have built upon the limitations of previous devices. However, there is still a need to innovate for increased clamp comfort and reduced reoperation rates for the AUS and sling.

Dataset Information

Delayed management of artificial urinary sphincter cuff erosion: a case series.

Background

Case description

Conclusions

Publications

Delayed management of artificial urinary sphincter cuff erosion: a case series.

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