Most men with artificial urinary sphincter cuff erosion have low serum testosterone levels

Abstract

Aims: To evaluate the relationship between serum testosterone (T) levels and artificial urinary sphincter (AUS) cuff erosion in a population of incontinent men who underwent AUS placement.Methods: A retrospective analysis of our single-surgeon AUS database was performed to identify men with T levels within 24 months of AUS placement.Men were stratified into two groups based on serum testosterone: low serum testosterone (LT) (<280 ng/dl) and normal serum testosterone (NT) (>280 ng/dl).Multivariable analysis was performed to control for risk factors. The outcome of interest was the incidence of and time to spontaneous urethral cuff erosion; other risk factors for cuff erosion were also evaluated.Results: Among 161 AUS patients with serum testosterone levels, 84 (52.2%) had LT (mean: 136.8 ng/dl, SD: 150.4 ng/dl) and 77 (47.8%) had NT (mean: 455.8 ng/dl, SD: 197.3 ng/dl). Cuff erosion was identified in 42 men (26.1%) at a median of 7.1 months postoperatively (interquartile range: 3.6-13.4 months), most of whom (30/42, 71.4%) were testosterone deficient. LT levels were less common (54/119, 45.4%) in the non-erosion cohort (p = 0.004). Men with low T were nearly three times as likely to suffer AUS erosion than men with normal T (odds ratio = 2.519, p = 0.021). LT level was the only factor associated with AUS erosion on multivariable analysis. Conclusions:LT is an independent risk factor for AUS cuff erosion. Men with LT are more likely to present with cuff erosion, but there is no difference in time to erosion.

Testosterone, Urethral Vascularity, and Urethral Stricture Disease: A Review

“…Men with TD were more likely to have urethral erosion (OR 2.519, p = 0.021). Again, on their multivariate analysis, TD was the only factor associated with urethral erosion [19].…”

“…Interestingly, on multivariate analysis, radiation was not associated with AUS erosion although a higher number of patients with erosion had prior radiation therapy (80% vs 51%, p = 0.038) [18]. The same group performed a larger retrospective review of all patients who underwent AUS by a single surgeon [19]. They identified 161 men who underwent AUS and had a perioperative serum testosterone level.…”

“…Over the last 5-6 years, much has been learned regarding the impact of testosterone on urethral vascularity and stricture disease (Table 1, Ref [18,19,[23][24][25][26][27][28]). However, there is still more work to be done as this emerging area translates into clinical practice.…”

Presenting signs and symptoms of artificial urinary sphincter cuff erosion

“…For men in the erosion cohort, average testosterone level at time of erosion was 222.0 ng/dL±177 ng/dL (IQR 237.5). As previously described, low testosterone is a known risk factor for AUS cuff erosion (14). We did not have testosterone levels for the non-erosion cohort as these are not routinely drawn.…”

“…History of prior pelvic radiation has been associated with both a shorter time to and higher likelihood of cuff erosion (5)(6)(7)(8)(9)(10)(11)(12). Other implicated risk factors include hypertension (12), diabetes (13), cardiovascular disease (12,13), low testosterone (14), urethral catheter (15), penile prosthesis placement (16), prior urethral surgery (9,17,18), and prior cuff erosion (7,9,10,19,20).…”