title: Artificial Urinary Sphincter Outcomes in the "Fragile Urethra".
abstract: OBJECTIVE
  To assess artificial urinary sphincter (AUS) outcomes in challenging post-prostatectomy patients with a "fragile urethra" at risk for urethral erosion.
  
  
  METHODS
  An institutional retrospective review of all AUS placements between August 2004 and March 2014 was performed. A "fragile urethra" was defined as a history of pelvic radiation, previous failed AUS, previous urethroplasty, or cystoscopic and/or clinical findings of urethral atrophy. The primary outcome was continence, defined as requiring ≤1 pad per day. Secondary outcomes included 90-day complications, need for further treatment, change in continence pads, and patient-reported satisfaction.
  
  
  RESULTS
  Thirty patients were identified as having a "fragile urethra." Thirteen of these patients underwent a transcorporal AUS (TCAUS) and 17 had a standard AUS cuff placement. Seventeen patients had radiation, 8 had a previous eroded AUS, and 10 had a prior urethroplasty. Five patients had multiple risk factors for urethral erosion. Continence was achieved in 77% (23/30), 97% (29/30) were improved, and the mean change in pads was 6.0 ± 2.8. Only 7% (2/30) required explantation, both for erosion. When the TCAUS and standard AUS groups were compared, no differences were noted in continence rates (P = .43), improvement (P = 1.00), explantation rates (P = .18), or erosion rates (P = .18), despite TCAUS having a higher proportion of previous urethroplasties.
  
  
  CONCLUSIONS
  AUS is a viable treatment option for post-prostatectomy incontinence, even in the fragile urethra. TCAUS may be utilized in patients with a very high risk for atrophy with similar continence and complication rates compared with standard AUS.
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Nathan Y
authors.initials: NY
authors.lastname: Hoy
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. Electronic address: krourke@ualberta.ca.
authors.forename: Keith F
authors.initials: KF
authors.lastname: Rourke
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014554:Urination; D013521:Urologic Surgical Procedures, Male / Q000379:methods*