The Fragile Urethra as a Predictor of Early Artificial Urinary Sphincter Erosion

OBJECTIVES To identify predictors of early artificial sphincter (AUS) erosion among a cohort of men with erosion, who underwent AUS placement by either university or community-based surgeons. METHODS The records of all patients with AUS erosions, including men who underwent AUS placement at outside facilities, were retrospectively reviewed. A Cox proportional-hazards model for time to erosion was performed with the predictors being the components of a fragile urethra (history of radiation, prior AUS, prior urethroplasty), androgen deprivation therapy (ADT), trans-corporal (TC), and 3.5 cm cuff, controlling for other risk factors. Kaplan-Meier survival curves and logrank test compared fragile urethras with not fragile urethras. All statistical analysis was done using R version 3.5.2. RESULTS Of the 156 men included, 36% had undergone AUS placement in the community. Median time to erosion was 16.0 months (1.0-240.0 months), and 122 (78%) met at least one fragility criteria. Radiation (HR 2.36, 95% CI 1.52-3.64) and prior urethroplasty (HR 2.12, 95% CI 1.18-3.80) were independently associated with earlier time to erosion. The Kaplan-Meier estimates demonstrate 1- and 5-year survival rates of 76.5% and 50.0%, respectively, for non-fragile and 44.1% and 14.8% for fragile urethras (P <.0001). CONCLUSION In a diverse cohort of men with AUS erosion, men with fragile urethras eroded sooner. Radiation and prior urethroplasty were independent risk factors for earlier time to erosion, but prior AUS, ADT, TC and 3.5 cm cuff were not. UROLOGY 169: 233-236, 2022. (c) 2022 Elsevier Inc.

Automated summary

This study retrospectively reviewed the records of male patients with artificial sphincter (AUS) erosion and identified radiation therapy and prior urethroplasty as independent risk factors for early erosion.