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Transcorporeal artificial urinary sphincter: Does this technique reduce the risk of erosion in high-risk patients?
Mina Khorashadi, BS, Arthur Mourtzinos, MD, Leonard Zinman, MD, Alex Vanni, MD.
Lahey Clinic, Burlington, MA, USA.

Background
The artificial urinary sphincter (AUS) is the gold standard treatment for male stress urinary incontinence. Prior studies have shown that the risk of explantation at 5 years ranges from 28-53% in simple cases. However, the risk of erosion has been shown to be 2-4 fold higher in patients with a history of radiation or prior AUS placement. The transcorporeal method, which adds bulk to the urethra by leaving the corporal tissue on the dorsal surface of the urethra, is often used in high-risk patients with history of radiation therapy or urethroplasty in order to reduce the rate of erosion. While, a transcorporeal AUS is often utilized in attempt to reduce the risk of erosions in high-risk patient, there is little data supporting this practice. The objective of our study was to evaluate whether placement of a transcorporeal AUS reduced the risk of erosion in high-risk patients with a history of radiation, prior AUS placement, rectourethral fistula (RUF) repair, or urethroplasty.
Methods:
We retrospectively reviewed the records of 274 patients who were implanted with an AUS from January 2003 to February 2014 at a single institution. High-risk patients were identified and defined as having had prior pelvic radiation therapy, prior AUS placement, RUF repair or urethroplasty. Demographics and erosion rates were compered between the groups.
Results:
187 high-risk patients were identified for analysis with a median age of 68 years and a median follow-up of 1.4 years. 73 patients had a history of prior radiation therapy, with 41 (56%) patients undergoing a transcorporeal approach. 78 patients had a history of prior AUS placement, with 28 (36%) placed transcorporeally. 23 patients had a prior urethroplasty, with 15 (65%) having a transcorporeal approach. 13 patients had a prior RUF repair with 7 (54%) undergoing a transcorporeal approach.
There was no significant difference in erosion rates between the standard and the transcorporeal groups in patients with a history of prior radiation (p= 0.905) or urethroplasty (p=0.28).
Conclusions:
The transcorporeal technique has been accepted as a safe and useful method of AUS insertion in patients at high risk for urethral erosion. While this technique is effective in treating incontinence, our results indicate that it does not have a significant effect on reducing the rate of erosion. Further multi-institutional investigation is necessary to further evaluate the effectiveness of the transcorporeal approach in high-risk patients.


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