AUA 2017: Artificial Urinary Sphincters

Boston, MA ( Dr. Ouida Lenaine Westney presented the approach to recurrent bladder neck contractures in patients with an artificial urinary sphincter already in place. She recommends making a perineal incision to open the cuff and then using a resectoscope to open the contracture. Additionally, smaller scopes can be used, such as a pediatric cystoscope or a semi-rigid ureteroscope. Balloon dilation of the contracture under fluoroscopy is also a potential option.

Dr. Will Brant reviewed AUS complications. To avoid iatrogenic injury during AUS placement he recommends using sharp dissection and interrogating the urethra prior to cuff placement.
Urethral erosion is a known complication with AUS and is more likely in patients with prolonged catheterization, a history of radiation therapy, or those with a history of a revision. If a catheter is going to be in place for more than one week, a suprapubic tube is recommended.
He cautioned against using a double cuff. When addressing the use of a transcorporal cuff, it is possible for patients to have one implanted with an inflatable penile prosthesis in place or have an IPP implanted after a transcorporal AUS.
He did not recommend leaving a PRB in place after AUS removal as these are colonized and can result in significant infectious sequelae.

Dr. Roger Dmochowski addressed cuff atrophy. He defined this as a urethra with a 3.5 cm circumference. Patients with a history of prior prostatectomy or radiation, older men, and a history of pelvic surgery are at more risk for developing cuff atrophy. The best way to avoid cuff atrophy is to appropriately size the cuff at the time of placement. When evaluating a patient for possible cuff atrophy, it is important to also consider possible failure of the pressure regulating balloon.

Dr. Melissa Kaufman discussed cuff erosion. Primary implants have a 2-15% risk of erosion. These patients can present with incontinence, obstruction, infection or hematuria. When suspicious of an erosion, a cystoscopy should be performed and if an erosion is present, the device explanted. Urethal stricture after erosion ranges from 8-40%

Written By: Lisa Parrillo, MD, Genitourinary Reconstructive Surgery Fellow, University of Colorado
