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Dorsolateral fibromuscular tissue preservation during artificial urinary sphincter cuff placement is associated with low infection and erosion rates
Author(s) -
Cheung Felix,
Fathollahi Ali,
Vertosick Emily,
Jarvis Thomas R.,
Katz Darren,
Sandhu Jaspreet S.
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14476
Subject(s) - medicine , artificial urinary sphincter , surgery , urethra , population , prostatectomy , confidence interval , urinary incontinence , muscle contracture , neck of urinary bladder , urology , urinary bladder , prostate , environmental health , cancer
Objectives To present a modified technique in artificial urinary sphincter (AUS) placement that is associated with low rates of erosion and infection in a high‐risk population. Patients and Methods After Institutional Review Board approval, we identified patients who underwent primary AUS placement using the modified technique between January 2007 and November 2015. Our modification consists of preserving the dorsolateral fibromuscular tissue surrounding the bulbar urethra and horizontally transecting the ventral bulbospongiosus muscle during urethral cuff placement. Preoperative variables such as radiotherapy (RT) and bladder neck contractures were recorded. Effectiveness and complications including infections, erosions, and re‐operations were recorded at follow‐up. Results The new technique was used on 208 patients: 40% had a history of RT, including 15% who had had a salvage radical prostatectomy; 26% had had previous bladder neck contractures. No patients developed infection. Overall, erosion occurred in six (2.9%) patients and spontaneous erosions occurred in two (0.9%) during the study period. In all, 21 patients underwent re‐operation for device failure. The probability of re‐operation for ‘any’ reason was 7% (95% confidence interval [CI] 4–12%) at 1 year. The 1‐year social continence rate was 74% (95% CI 67–81%). Conclusion Preservation of dorsolateral fibromuscular tissue during AUS placement is an effective means to achieve a low risk of erosions. Our modified technique is safe with low infection and erosion rates, whilst maintaining good functional outcomes despite a high‐risk population.