Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach
ObjectivesThe objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management i...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-02-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.829517/full |
| _version_ | 1819274594015510528 |
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| author | Katharina Kuhlencord Roland Dahlem Malte W. Vetterlein Raisa S. Abrams-Pompe Valentin Maurer Christian P. Meyer Silke Riechardt Margit Fisch Tim A. Ludwig Phillip Marks |
| author_facet | Katharina Kuhlencord Roland Dahlem Malte W. Vetterlein Raisa S. Abrams-Pompe Valentin Maurer Christian P. Meyer Silke Riechardt Margit Fisch Tim A. Ludwig Phillip Marks |
| author_sort | Katharina Kuhlencord |
| collection | DOAJ |
| description | ObjectivesThe objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation.Patients and MethodsData of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009 to 2015. In case of cuff erosion, AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation or mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for 3 weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad test, uroflowmetry, postvoiding residual urine (PVR), and radiography. Primary endpoint was urethral stricture rate.ResultsOut of 235 patients after AUS implantation, 24 (10.2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation, 2 patients (8.3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17 ml/s without suspicion of urethral stricture. Median time to reimplantation was 4 months (IQR 3-4).ConclusionWe observed a considerably low stricture formation and could not prove an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore, the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion. |
| first_indexed | 2024-12-23T23:10:54Z |
| format | Article |
| id | doaj.art-fef78aa2a5c8476c8bd9a0a4b07cb9c3 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-23T23:10:54Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-fef78aa2a5c8476c8bd9a0a4b07cb9c32022-12-21T17:26:40ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-02-01910.3389/fsurg.2022.829517829517Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation ApproachKatharina Kuhlencord0Roland Dahlem1Malte W. Vetterlein2Raisa S. Abrams-Pompe3Valentin Maurer4Christian P. Meyer5Silke Riechardt6Margit Fisch7Tim A. Ludwig8Phillip Marks9Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Urology, Asklepios Medical Center Harburg, Hamburg, GermanyDepartment of Urology, Clinic Herfurt, University of Bochum, Herfurt, GermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyObjectivesThe objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation.Patients and MethodsData of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009 to 2015. In case of cuff erosion, AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation or mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for 3 weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad test, uroflowmetry, postvoiding residual urine (PVR), and radiography. Primary endpoint was urethral stricture rate.ResultsOut of 235 patients after AUS implantation, 24 (10.2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation, 2 patients (8.3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17 ml/s without suspicion of urethral stricture. Median time to reimplantation was 4 months (IQR 3-4).ConclusionWe observed a considerably low stricture formation and could not prove an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore, the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion.https://www.frontiersin.org/articles/10.3389/fsurg.2022.829517/fullcomplicationsAMS 800™artificial urinary sphincterurethral erosionreconstructive urologystress urinary incontinence |
| spellingShingle | Katharina Kuhlencord Roland Dahlem Malte W. Vetterlein Raisa S. Abrams-Pompe Valentin Maurer Christian P. Meyer Silke Riechardt Margit Fisch Tim A. Ludwig Phillip Marks Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach Frontiers in Surgery complications AMS 800™ artificial urinary sphincter urethral erosion reconstructive urology stress urinary incontinence |
| title | Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach |
| title_full | Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach |
| title_fullStr | Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach |
| title_full_unstemmed | Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach |
| title_short | Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach |
| title_sort | urethral stricture formation following cuff erosion of ams artificial urinary sphincter devices implication for a less invasive explantation approach |
| topic | complications AMS 800™ artificial urinary sphincter urethral erosion reconstructive urology stress urinary incontinence |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.829517/full |
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