From the Guidelines
Artificial urinary sphincter (AUS) erosion is a serious complication that requires prompt removal of all device components to prevent further complications, and a waiting period of three to six months is recommended before considering reimplantation 1. When AUS erosion occurs, it is essential to remove the device as soon as possible to prevent infection, urethral damage, and other complications. The removal procedure involves taking out all components of the AUS, including the cuff, pump, and reservoir.
- Key considerations in the management of AUS erosion include:
- Prompt surgical intervention to remove the device
- Administration of broad-spectrum antibiotics preoperatively and postoperatively
- A waiting period of 3-6 months before reimplantation to allow for complete healing and resolution of infection
- Alternative continence management strategies during the waiting period, such as pads, condom catheters, or penile clamps
- Risk factors for AUS erosion include prior radiation therapy, urethral atrophy, previous urethral surgery, and improper cuff sizing, as these factors can increase the likelihood of device failure and erosion 1.
- Symptoms of AUS erosion may include pain, swelling, difficulty urinating, recurrent urinary tract infections, or return of urinary incontinence, and early recognition and management are crucial to minimize long-term urethral damage and improve outcomes for potential future device reimplantation.
- The management of AUS erosion should prioritize minimizing morbidity, mortality, and improving quality of life, and the recommended waiting period of 3-6 months before reimplantation is based on the most recent guideline evidence 1.
From the Research
Causes of Artificial Urinary Sphincter (AUS) Erosion
- Infection, erosion, mechanical failure, atrophy, and balloon deterioration can cause device malfunction in approximately half of patients by 10 years after implantation 2
- Urethral erosions are a known complication of AUS implantation, with a median time to explantation of 21 months 3
- The temporal trend of AUS erosions demonstrates a peak in the 1st year, with a gradual tapering of cases thereafter, persisting beyond 10 years 3
Management of AUS Erosion
- If there is infection or erosion, all devices should be removed first, and a new device should be implanted several months later 2
- Device removal and simultaneous implantation can be performed in the absence of infection or erosion 2
- Intraoperative assessment of urethral health is necessary for device removal and implantation 2
- Nonsurgical management of sterile AUS cuff erosion may be possible in some cases, with patients remaining continent and infection-free despite chronic erosion 4
- Delayed management of asymptomatic AUS cuff erosion may be an option, with no urgent device explantation necessary 5
- Effective treatment of AUS erosion and infection is crucial to address the acute clinical problem and provide the patient with the best chance of pursuing AUS replacement surgery in the future 6
Considerations for AUS Revision Surgery
- Patients for whom revision surgery is considered should be examined physically and by interview for signs of infection 2
- Urethral erosion should be assessed using cystoscopy 2
- Transcorporal cuff implantation is a safe choice after strong adhesion around the urethra 2
- The entire device should be replaced due to device aging and deterioration if a long time has passed since device implantation 2