Artificial urinary sphincter erosion linked to history of pelvic radiation

A recent study has shown that artificial urinary sphincter cuff erosion neither causes urethral stricture formation nor contributes to a degree of erosion.

“Those who develop strictures nearly always have a history of pelvic radiation,” said the investigators who reviewed the database for all patients with artificial urinary sphincter erosion from 2011 to 2022.

A graded scale was used to compare the incidence of postoperative stricture development to the severity of erosion: 1, <25-percent circumference; 2, 25- to 50-percent circumference; 3, >50- and <100-percent circumference; 4, 100-percent circumference.

A total of 862 artificial urinary sphincter surgeries were performed, from which 102 erosion cases were identified, and 63 with documented erosion severity were analysed. Twenty-eight cases without documented erosion severity were further analysed for validation.

Urethral stricture developed in 22 patients (34.9 percent) within the main cohort. The incidence of stricture did not differ by grade of erosion (p=0.73) and was not significantly higher in men with grade 4 erosion compared with lower-grade erosions (32.7 percent vs 50.0 percent; p=0.34).

Radiation exposure resulted in a 41.1-percent higher incidence of stricture (p<0.01). Almost all strictures occurred in the setting of prior radiation (21 of 22; 95.5 percent). In the validation cohort, 10 (35.7 percent) developed stricture, mostly in the radiation setting (eight of 10; 80 percent).

Notably, nearly all cases of stricture (29 of 32; 90.6 percent) had a history or radiation.