Simultaneous augmentation cystoplasty is associated with earlier rather than increased artificial urinary sphincter infection.
OBJECTIVE
While artificial urinary sphincter infection or erosion occurs in 20% of implantations, the risk factors are poorly understood. One of the most contentious factors reported to increase prosthesis infection is simultaneous sphincter implantation and augmentation cystoplasty. In contrast to some reports, to date our results have not shown an increased infective risk with the simultaneous procedure. We reviewed the long-term infective complications of 195 sphincters to investigate for predisposing infective factors and review the role of augmentation cystoplasty.


METHODS
We performed a retrospective case note review of 144 patients with a median followup of 112 months. Augmentation cystoplasty performed in 86 patients (60%) and was simultaneous in 56. All patients were reviewed within the last year or followed until death or sphincter failure. Patient, surgical and treatment factors were statistically analyzed for associations with prosthesis infection.


RESULTS
A total of 108 sphincters failed from infection (25%), tissue atrophy (5%) or mechanical reasons (25%). The overall infective failure rate was similar in patients who underwent simultaneous augmentation (30%) compared with the other patients (23%), although there was a statistically significant difference within the first 3 postoperative years (log rank p = 0.009). While no other variables were significantly associated with sphincter infection, intermittent self-catheterization did not increase sphincter infection and females appeared to have more prosthesis infections.


CONCLUSIONS
Our results suggest that, while simultaneous augmentation cystoplasty and artificial urinary sphincter implantation lead to an initial increase in prosthesis infection, this difference disappears after 3 years.
Catto
J W F
JW
Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, United Kingdom. J.Catto@sheffield.ac.uk
Natarajan
V
V
Tophill
P R
PR
D000328:Adult; D000368:Aged; D001284:Atrophy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D001743:Urinary Bladder / Q000473:pathology; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014546:Urinary Catheterization; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects