Is Risk of Artificial Urethral Sphincter Cuff Erosion Higher in Patients with Penile Prosthesis?
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.
['Sundaram|Varun|V|', 'Cordon|Billy H|BH|', 'Hofer|Matthias D|MD|', 'Morey|Allen F|AF|']
D000368:Aged D020878:Device Removal D007172:Erectile Dysfunction D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D019935:Penile Implantation D015917:Penile Prosthesis D011468:Prostatectomy D011475:Prosthesis Failure D012189:Retrospective Studies D012306:Risk D014521:Urethra D014546:Urinary Catheterization D016741:Urinary Sphincter, Artificial
Artificial Urethral Sphincter Erosion Penile Prosthesis Stress Urinary Incontinence