Presenting signs and symptoms of artificial urinary sphincter cuff erosion

Diao, Linley; Nealon, Samantha W.; Carpinito, Gianpaolo; Badkhshan, Shervin; Wolfe, Audrey E; Dropkin, Benjamin M.; Sanders, Sarah C.; Hudak, Steven J.; Morey, Allen F.

doi:10.1590/s1677-5538.ibju.2022.0089

Int. braz j urol.

2022

DOI: 10.1590/s1677-5538.ibju.2022.0089

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Presenting signs and symptoms of artificial urinary sphincter cuff erosion

Linley Diao

Samantha W. Nealon

Gianpaolo Carpinito

et al.

Abstract: Purpose: To characterize the most common presentation and clinical risk factors for artificial urinary sphincter (AUS) cuff erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these patients. Materials and Methods: We retrospectively reviewed our tertiary center database to identify men who presented with AUS cuff erosion between 2007 -2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for sympt… Show more

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“…Dr. Diao and colleagues from USA performed in page 679 (6) a nice study about the signs and symptoms of artificial urinary sphincter cuff erosion and concluded that artificial urinary sphincther cuff erosion most commonly presents as localized scrotal inflamation symptoms. Obstructive voiding symptoms and worsening incontinence are also common.…”

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confidence: 99%

Vesical imaging reporting and data system (VI-RADS) in bladder cancer diagnosis in review in this number of International Brazilian Journal of Urology

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2022

Int. braz j urol.

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The papers came from many different countries such as Brazil, USA, Turkey, China, Belgium, Qatar and Colombia and as usual the editor´s comment highlights some of them.In the present issue we present a important reviews about Vesical Imaging Reporting and Data System (VI-RADS) in bladder cancer diagnosis. The paper about the group of Dr.Nicola and colleagues from USA and Brazil in page 609 shows a very complete narrative review about the topic (1). The authors shows that. the technological innovation of MR imaging has advanced the assessment of bladder cancer. MR findings can be incorporated to increase the accuracy of the traditional prediction models as the EORTC, CUETO, and EAU risk stratification. The authors conclude that the use and implication of VI-RADS will improve the communication in the diagnosis, staging and surveillance of patients with bladder cancer. The editor in chief would like to highlight the following works too:Dr. Bai and colleagues from China, presented in page 625 (2) a nice systematic review about the trifecta achievement in patients undergoing partial nephrectomy and conclude that the larger tumor size, medium and high PADUA score are associated with decreased probability of trifecta achievement.Dr. Qin and colleagues from China performed in page 637 (3) a interesting systematic review about the Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2cm and concluded that in the treatment of >2cm renal stones, mini-PCNL should be considered an effective and reliable alternative to standard-PCNL (30FR) with less blood loss, lower transfusion rate, and shorter hospitalization. However, the mini-PCNL does not show a significant advantage over the 24F standard-PCNL. On the contrary, this procedure takes a longer operation time.Dr. Terziotti and colleagues from Brazil performed in page 649 (4) an interesting retrospective study about the incontinence outcomes in women undergoing retropubic mid-urethral sling and conclude that both hand-made synthetic sling (HMS) and SafyreTM have similar satisfaction and subjective cure rates, with marked International Consultation on Incontinence Modular Questionnaire

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confidence: 99%

Vesical imaging reporting and data system (VI-RADS) in bladder cancer diagnosis in review in this number of International Brazilian Journal of Urology

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2022

Int. braz j urol.

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Surgical Management of Male Stress Urinary Incontinence: Artificial Urinary Sphincter Versus Male Slings

Johnson

Morey²

2022

Curr Sex Health Rep

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Impact of artificial urinary sphincter erosion in the reimplantation of the device

Cavalcanti

2022

Int. braz j urol.

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In this article, the authors assess the clinical presentation of patients with urethral cuff erosion after the implant of an Artificial Urinary Sphincter (AUS) and also attempt to establish risk factors in this patient population (1). As well pointed out by the authors, this complication has an extreme impact on the treatment of these patients, both in the acute phase, associated with the inflammatory and infectious condition, and late related to the reimplantation of the device. Replantation of AUS after erosion is certainly one of the most challenging conditions in the management of male urinary incontinence. Despite the literature describing statistical data and risk factors for erosion, these hardly describe details about the evolution characteristics of this process. As observed by the authors, most patients present with inflammatory signs in the scrotum, but a significant part of patients (about 1/3) do not present these symptoms, and will exclusively have urinary symptoms (obstruction or incontinence relapse) (2). This is an important finding because even in the absence of inflammatory signs, erosion should be suspected when there are urinary symptoms, whether obstructive or incontinence relapse. In the case of obstructive symptoms, it is important to analyze whether there is a reference to urethral stenosis or urethro-vesical anastomosis in the patient's clinical history for the differential diagnosis. In the case of incontinence relapse, it is usually more acute when compared to other causes such as urethral atrophy. As well demonstrated in the study, these symptoms can present in combination. In the study, inflammatory symptoms are more associated with obstruction, perhaps due to greater urine leakage, a fact that also justifies lower rates of the combination of incontinence relapse and inflammation. The presence of radiotherapy was more common in patients with erosion when compared to those without erosion, as well as hypertension, coronary heart disease and smoking. The identification of risk factors is essential for patient consent, as well as for technical interventions to be taken to prevent the problem at the time of implantation of the prosthesis. The authors did not demonstrate previous procedures such as urethroplasty as risk factors in this study, but in our opinion, all patients who have an established impact on urethral vascularization a risk factor for cuff erosion. In the specific case of urethroplasty, we should try to preserve the urethra vascularization in all patients who are at risk of developing postoperative incontinence. Early recognition of cuff erosion is critical for an early approach that is likely to be associated with less urethral damage.

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Presenting signs and symptoms of artificial urinary sphincter cuff erosion

Cited by 4 publications

References 27 publications

Vesical imaging reporting and data system (VI-RADS) in bladder cancer diagnosis in review in this number of International Brazilian Journal of Urology

Vesical imaging reporting and data system (VI-RADS) in bladder cancer diagnosis in review in this number of International Brazilian Journal of Urology

Surgical Management of Male Stress Urinary Incontinence: Artificial Urinary Sphincter Versus Male Slings

Impact of artificial urinary sphincter erosion in the reimplantation of the device

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