title: 3.5 cm artificial urinary sphincter cuff erosion occurs predominantly in irradiated patients.
abstract: OBJECTIVE
  We analyzed our initial 100-case experience with the 3.5 cm artificial urinary sphincter cuff to identify risk factors for cuff erosion.
  
  
  METHODS
  We reviewed the records of a single surgeon, consecutive series of patients treated with 3.5 cm artificial urinary sphincter cuff placement from September 2009 to August 2013. Each patient underwent single perineal cuff placement via standardized technique. Preoperative characteristics, technical considerations and postoperative outcomes were analyzed and compared to those in a cohort of patients in whom a larger (4.0 cm or greater) artificial urinary sphincter cuff was placed during the same period. We identified clinical factors associated with an increased risk of 3.5 cm artificial urinary sphincter cuff erosion.
  
  
  RESULTS
  Of the 176 men who met study inclusion criteria during the 4-year period 100 (57%) received the 3.5 cm artificial urinary sphincter cuff and 76 (43%) received a larger cuff (4.0 cm or greater). The continence rate (83% vs 80%, p = 0.65) and mean followup (32 vs 25 months, p = 0.14) were similar in the 2 groups. Erosion developed in 16 of the 176 patients (9%) during the study period, of whom 13 had the 3.5 cm cuff. Of the 100 patients with the 3.5 cm cuff 52 (52%) had a history of radiation, including 11 (21%) with erosion. Cuff erosion developed only rarely in nonirradiated men (2 of 48 or 4%, p = 0.01). A history of radiation was the only significant risk factor associated with 3.5 cm cuff erosion (OR 6.2, 95% CI 1.3-29.5).
  
  
  CONCLUSIONS
  Men with a history of radiation who underwent placement of a 3.5 cm artificial urinary sphincter cuff experienced an increased (21%) risk of cuff erosion.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: allen.morey@utsouthwestern.edu.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Nirmish
authors.initials: N
authors.lastname: Singla
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: J Francis
authors.initials: JF
authors.lastname: Scott
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Lemack
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016741:Urinary Sphincter, Artificial
keywords: artificial; complications; stress; urethra; urinary bladder; urinary incontinence; urinary sphincter