Mp06-13 Low Rate of Urethral Stricture After Removal of Artificial Urinary Sphincter for Urethral Erosion, When Managed With Catheter Alone

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (including stricture) I (MP06)1 May 2024MP06-13 LOW RATE OF URETHRAL STRICTURE AFTER REMOVAL OF ARTIFICIAL URINARY SPHINCTER FOR URETHRAL EROSION, WHEN MANAGED WITH CATHETER ALONE Anastasia V. Frost, Agusti Marfany Pluchart, Mariya Dragova, Angelica Lock, Daniela Andrich, and Anthony Mundy Anastasia V. FrostAnastasia V. Frost , Agusti Marfany PluchartAgusti Marfany Pluchart , Mariya DragovaMariya Dragova , Angelica LockAngelica Lock , Daniela AndrichDaniela Andrich , and Anthony MundyAnthony Mundy View All Author Informationhttps://doi.org/10.1097/01.JU.0001009452.79331.fd.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral erosion is a devastating complication in patients with a bulbar artificial urinary sphincter (AUS). At the time of AUS removal, urethral erosion can be managed by leaving the urethra open and allowing it to heal over a catheter, or by performing urethroplasty to close the defect. The literature reports stricture rates of 8-85% with catheter alone, compared to 14%-38% with urethroplasty. We describe our experience managing urethral erosion with catheter alone. METHODS: Erosion is diagnosed by cystoscopy, at which time the AUS is deactivated and a 14Fr catheter placed until definitive surgery. AUS removal is undertaken within 2 weeks of erosion detection, or within 72 hours if there is concomitant infection. The AUS is removed in the standard way. Urethral defects are not surgically repaired and are left to heal over a 14F catheter for 3-4 weeks before pericatheter urethrogram to ensure urethral healing. Follow-up entails retrograde urethrogram (RUG) at 3 and 12 months post AUS removal. Where narrowing is seen on RUG, cystoscopy is performed with a 17F cystoscope. Stricture was defined as the inability to pass a cystoscope to the bladder neck. We reviewed our prospective database and identified 41 patients who had urethral erosion requiring bulbar AUS removal from January 2006 to July 2018. Median time from implant to explant was 8 months (range 15 days – 19 years). 36 patients (86%) were evaluable with at least 1 year follow-up, and 3 and 12 month post-operative RUG. Mean age was 67 years (range 30 – 87 years). Indications for AUS included 26 patients with incontinence following prostate cancer treatment, 14 of whom had had radiotherapy (RTX). The remaining 10 patients had various benign disorders. 27 devices were primary implants, 7 were redo and 2 were replacements. RESULTS: Erosion severity was described as percentage of urethral circumference affected: 10% (n=6), 25% (n=8), 50% (n=7), 100% (n=1) or "not recorded" (n=14). Two patients (5.6%) developed a urethral stricture after AUS removal. The first patient had 50% erosion, on a background of prostatectomy and RTX for prostate cancer. The second patient had 100% erosion, on a background of prior urethral reconstruction for pelvic fracture urethral injury. 22 patients (61%) had subsequent redo AUS implantation at a minimum of 6 months post explant. CONCLUSIONS: We demonstrate low urethral stricture rates by leaving a catheter alone when removing an AUS for erosion. Prompt AUS removal after diagnosis of erosion may help minimise the risk of urethral stricture. Source of Funding: Nil © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e56 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Anastasia V. Frost More articles by this author Agusti Marfany Pluchart More articles by this author Mariya Dragova More articles by this author Angelica Lock More articles by this author Daniela Andrich More articles by this author Anthony Mundy More articles by this author Expand All Advertisement PDF downloadLoading ...