title: Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study.
abstract: OBJECTIVE
  To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection.
  
  
  METHODS
  A prospective outcome analysis was performed on 386 patients treated with AUS placement from April 2009 to December 2012 at 8 institutions with at least 3 months of follow-up. Charts were analyzed for preoperative risk factors and postoperative complications requiring explantation.
  
  
  RESULTS
  Approximately 50% of patients were considered high risk. High risk was defined as patients having undergone radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS. A total of 31 explantations (8.03%) were performed during the follow-up period. Overall explantation rates were higher in those with prior radiation and prior UroLume. Men with prior AUS infection or erosion also had a trend for higher rates of subsequent explantation. Men receiving 3.5-cm cuffs had significantly higher explantation rates than those receiving larger cuffs.
  
  
  CONCLUSIONS
  This outcomes study confirms that urethral risk factors, including radiation history, prior AUS erosion, and a history of urethral stent placement, increase the risk of AUS explantation in short-term follow-up.
authors.affiliation: Department of Surgery, Division of Urology, Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT. Electronic address: Dr.w.brant@gmail.com.
authors.forename: William O
authors.initials: WO
authors.lastname: Brant
authors.affiliation: Department of Urology, University of Iowa, Iowa City, IA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Christopher
authors.initials: C
authors.lastname: Powell
authors.affiliation: Department of Urology, Loyola University, Chicago, IL.
authors.forename: Nejd
authors.initials: N
authors.lastname: Alsikafi
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Christopher
authors.initials: C
authors.lastname: McClung
authors.affiliation: Department of Surgery, Division of Urology, Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
authors.affiliation: Department of Urology, University of Washington, Seattle, WA.
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Voelzke
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Smith
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Broghammer
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D011475:Prosthesis Failure; D012307:Risk Factors; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects*
references.citation: Eur Urol. 2009 May;55(5):1037-63
references.pmid: 19185977
references.citation: J Urol. 2007 Mar;177(3):1021-5
references.pmid: 17296403
references.citation: J Urol. 1986 Jul;136(1):102-3
references.pmid: 3712591
references.citation: J Urol. 2006 Jun;175(6):2186-90; discussion 2190
references.pmid: 16697836
references.citation: J Urol. 2013 May;189(5):1777-81
references.pmid: 23206425
references.citation: Curr Opin Urol. 2010 Jul;20(4):302-8
references.pmid: 20531090
references.citation: Urology. 2008 Oct;72(4):825-7
references.pmid: 18752838
references.citation: Int J Urol. 2012 Sep;19(9):861-6
references.pmid: 22571275
references.citation: BJU Int. 2002 Mar;89(4):364-8
references.pmid: 11872025
references.citation: J Urol. 2011 Nov;186(5):1962-6
references.pmid: 21944140
references.citation: J Urol. 2005 Apr;173(4):1242-5
references.pmid: 15758761
references.citation: Urology. 2012 Apr;79(4):933-8
references.pmid: 22119252
references.citation: BJU Int. 2005 Apr;95(6):824-6
references.pmid: 15794791
references.citation: Urology. 2012 Apr;79(4):922-8
references.pmid: 22305763
references.citation: J Urol. 2002 May;167(5):2075-8; discussion 2079
references.pmid: 11956443
references.citation: J Urol. 2012 Mar;187(3):951-5
references.pmid: 22264456
references.citation: Can J Urol. 2013 Jun;20(3):6773-7
references.pmid: 23783046
references.citation: J Urol. 2013 Feb;189(2):602-8
references.pmid: 23017528