Dorsolateral Fibromuscular Tissue Preservation During Artificial Urinary Sphincter Cuff Placement is Associated with Low Infection and Erosion Rates

Author Type(s)

Resident/Fellow

Document Type

Article

Publication Date

February 2019

DOI

10.1111/bju.14476

Journal Title

BJU international

Keywords

artificial urinary sphincter, erosion, infection, prostatectomy, stress incontinenceLR: 20190118; CI: (c) 2018 The Authors BJU International (c) 2018; GR: P30 CA008748/The Sidney Kimmel Center for Prostate and Urologic Cancers and the National Institutes of Health/National Cancer Institute to Memorial Sloan Kettering Cancer Center through the Cancer Center Support Grant; JID: 100886721; OTO: NOTNLM; 2018/07/05 06:00 [pubmed]; 2018/07/05 06:00 [medline]; 2018/07/05 06:00 [entrez]; ppublish

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVES: To present a modified technique in artificial urinary sphincter (AUS) placement that is associated with low rates of erosion and infection in a high-risk population. PATIENTS AND METHODS: After Institutional Review Board approval, we identified patients who underwent primary AUS placement using the modified technique between January 2007 and November 2015. Our modification consists of preserving the dorsolateral fibromuscular tissue surrounding the bulbar urethra and horizontally transecting the ventral bulbospongiosus muscle during urethral cuff placement. Preoperative variables such as radiotherapy (RT) and bladder neck contractures were recorded. Effectiveness and complications including infections, erosions, and re-operations were recorded at follow-up. RESULTS: The new technique was used on 208 patients: 40% had a history of RT, including 15% who had had a salvage radical prostatectomy; 26% had had previous bladder neck contractures. No patients developed infection. Overall, erosion occurred in six (2.9%) patients and spontaneous erosions occurred in two (0.9%) during the study period. In all, 21 patients underwent re-operation for device failure. The probability of re-operation for 'any' reason was 7% (95% confidence interval [CI] 4-12%) at 1 year. The 1-year social continence rate was 74% (95% CI 67-81%). CONCLUSION: Preservation of dorsolateral fibromuscular tissue during AUS placement is an effective means to achieve a low risk of erosions. Our modified technique is safe with low infection and erosion rates, whilst maintaining good functional outcomes despite a high-risk population.

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