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.
in the T-group and 85% in CTRL were on alpha-blockers at baseline. 2% of men in the T-group and 19% in CTRL were on 5a-reductase inhibitors at baseline. 19% of men in the T-group and 27% in CTRL were on PDE5-inhibitors at baseline.In the T-group, IPSS decreased from 10.6AE2.1 to 2.2AE0.7 at 10 years (p<0.0001). In CTRL, IPSS remained stable. The estimated adjusted difference between groups at 10 years was 2.4 (p<0.01). Post-voiding residual volume decreased in the T-group from 69.9AE12.9 to 10.3AE1.7 mL at 10 years (p<0.0001) and increased in CTRL from 67.7AE11.2 to 71.7AE21.2 (p<0.001). Medication adherence to TTh was 100% as all injections were applied in the office and documented.CONCLUSIONS: TTh in hypogonadal men improves urinary function. Men with moderate IPSS achieve improvement into the mild IPSS category which is clinically meaningful. The improvements are maintained over a long period of time up to 10 years. In untreated hypogonadal men, urinary function worsens slightly with advancing age. Measuring testosterone in men presenting with LUTS and offering TTh when indicated results in benefits for urinary function.Source of Funding: Statistical analyses and data entry were partially funded by Bayer AG,
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.