Natural history of artificial urinary sphincter cuff erosion in males: Experience from two tertiary centres in the United Kingdom

Abstract

Objectives

This study aimed to describe the natural history of urethral cuff erosion (UCE) following artificial urinary sphincter (AUS) implantation, including the incidence of urethral stricture and fistula formation, and the outcomes of salvage AUS reimplantation, based on the experience of two UK tertiary centres.

Material and methods

Data collected prospectively from 2016 to 2024 was analysed retrospectively. Demographics, characteristics and outcomes of AUS re-implantation were analysed.

Results

A total of 273 AUS implantation were performed during the study period. Fifty had device explantation for UCE. Median age at explantation was 73 years. Median time from implantation to erosion was 32 months. About 12% had a history of neurogenic bladder and 58% pelvic irradiation. The most significant cause of acute erosion was traumatic catheterisation (44%).

Following explantation, nine developed urethral stricture (18%), while five patients had urethro-cutaneous fistulae (10%). Twelve individuals underwent salvage AUS re-implantation with 6 (50%) requiring further explantation (50%) within 8 months. Of the remaining 38 patients, 17 continued with pad use alone and 21 underwent alternative conservative management including long-term catheterisation, convene drainage, penile clamp or urethral bulking. Four patients (8%) ultimately required urinary diversion, two following primary explantation and two following failed salvage reimplantation.

Conclusion

Overall, 18% of males having AUS implantation had UCE and explantation of the device. The vast majority of them had a history of pelvic irradiation or catheterisation for stricture disease (76%). The main risk for UCE was traumatic catheterisation. About 18% of explanted cases developed urethral stricture and 10% urethra-cutaneous fistulae. Only 24% of these patients had attempted salvage AUS re-implantation, with one half resulting in further early UCE/infection and removal.