Urethral Stricture Outcomes After Artificial Urinary Sphincter Cuff Erosion: Results From a Multicenter Retrospective Analysis.

OBJECTIVE: To evaluate the influence of both repair type and degree of cuff erosion on postoperative urethral stricture rate. Sparse literature exists regarding patient outcomes after artificial urinary sphincter (AUS) cuff erosion. Surgeons from 6 high-volume male continence centers compiled a comprehensive database of post-erosion patients to examine outcomes. MATERIALS AND METHODS: This retrospective multi-institution study included 80 patients treated for AUS cuff erosions. Seventy-eight patients had specific information regarding post-cuff erosion urethral strictures. Erosion patients were categorized into 1 of 3 repair types at the time of explant surgery: catheter only, single-layer capsule-to-capsule repair (urethrorrhaphy), and formal urethroplasty. Operative notes and available medical records were extensively reviewed to collect study data. RESULTS: Twenty-five of 78 patients manifested a urethral stricture after AUS cuff erosion (32%). More strictures occurred among patients who underwent urethrorrhaphy (40% vs 29% for catheter only and 14% for urethroplasty). Stricture rates did not vary significantly by repair type (P = .2). Strictures occurred significantly more frequently in patients with complete cuff erosions (58%) as compared to partial erosions (25%, P = .037). A trend was detected regarding increased percentage of erosion correlating with increased stricture rate, but this did not reach statistical significance (P = .057). Partially eroded patients were more likely to undergo urethrorrhaphy repair (60%, P = .002). CONCLUSION: Urethral stricture was more likely to occur after complete cuff erosion as opposed to partial erosion in this multicenter retrospective population. Repair type, whether catheter only, urethrorrhaphy, or formal urethroplasty, did not appear to influence postoperative stricture rate.

Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis.

A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.

The pursuit of prostate cancer in patients with a rising prostate-specific antigen and multiple negative transrectal ultrasound-guided prostate biopsies.

To determine if patients with persistently elevated prostate-specific antigen (PSA) levels who have had transrectal ultrasound (TRUS)-guided prostate biopsies negative for carcinoma will benefit from additional saturation (> or =14 cores) TRUS biopsies with or without transurethral (TUR) biopsies. A retrospective review of 35 men between ages 51-74 with PSA values between 4.5-46 ng/mL, normal digital rectal examinations, and > or =2 previously negative sextant TRUS biopsies. Seventeen patients had TUR biopsies in addition to saturation TRUS biopsies. Eighteen patients had saturation TRUS biopsies only (median 20 cores). Seven patients who had no cancer detected with the combined TRUS/TUR biopsies had an additional saturation biopsy performed (median 20 cores). Seven (20%) of the 35 patients who had a saturation biopsy had cancer detected, and one (5.9%) cancer was detected in the 17 men that had a TUR biopsy. Five (71.4%) of the seven patients who had an additional TRUS biopsy had cancer detected (total core range 45-60). The overall yield of prostate cancer was therefore 37.1%, with 1-9 cores positive (median 5 cores). For patients with a rising PSA and > or =2 negative sextant TRUS biopsies, the cancer yield of the initial saturation TRUS biopsies was 20%. Furthermore, a significant proportion of patients with negative initial saturation biopsies had cancer detected on repeat TRUS biopsy. The cancer yield of adding TUR biopsies in this same group of patients is < 6.