Objective To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection. Materials and Methods A prospective outcome analysis was performed on 386 patients treated with AUS placement from April 2009 to December 2012 at 8 institutions with at least 3 months of follow-up. Charts were analyzed for preoperative risk factors and postoperative complications requiring explantation. Results Approximately 50% of patients were considered high risk. High risk was defined as patients having undergone radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS. A total of 31 explantations (8.03%) were performed during the follow-up period. Overall explantation rates were higher in those with prior radiation and prior UroLume. Men with prior AUS infection or erosion also had a trend for higher rates of subsequent explantation. Men receiving 3.5-cm cuffs had significantly higher explantation rates than those receiving larger cuffs. Conclusion This outcomes study confirms that urethral risk factors, including radiation history, prior AUS erosion, and a history of urethral stent placement, increase the risk of AUS explantation in short-term follow-up.
Bibliographical noteFunding Information:
Funding Support: The funding source for this work is an unrestricted research grant to Dr. Brant from the Joe W. and Dorothy Dorsett Brown Foundation . There are no commercial sources of funding.
Financial Disclosure: William O. Brant is a consultant, proctor, meeting participant, and a grant recipient of American Medical Systems , a consultant and proctor in Coloplast, and a member of the Speaker's Bureau in Auxilium. Sean Elliott is a consultant in American Medical Systems and GT Urological, a grant recipient of Auxilium , and holds a leadership position in PercuVision. Nejd Alsikafi is a consultant in American Medical Systems. Jeremy Myers holds an unpaid leadership position in the International Volunteers in Urology. Joshua Broghammer is a consultant and proctor in American Medical Systems. The remaining authors declare that they have no relevant financial interests.
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