Is Prolonged Catheterization a Risk Factor for Artificial Urinary Sphincter Cuff Erosion?

Objective: To evaluate the relative risk of prolonged urethral catheterization (PC), >48 hours, on artificial urinary sphincter (AUS) cuff erosion in a tertiary referral population.

Methods: All men who had undergone AUS implantation or revision by multiple surgeons at our institution from 2000 to 2010 with ≥6 months of follow-up were reviewed for urethral erosion, catheterization after AUS placement, and comorbid conditions.

Results: Of the 258 AUS patients reviewed, 200 met the inclusion criteria, with an average follow-up of 24 months. AUS cuff erosions were noted in 24 men (12%) and were diagnosed at a mean of 16.9 months (range 0.8-87.1). PC was identified in 44 of the 200 men (22%)-of these men, erosions occurred in 17 (39%, P <.001). The indication for PC was most often major nongenitourinary surgery (36%) or urinary retention (32%). Univariate analysis identified an increased risk of erosion associated with hypertension, diabetes, coronary artery disease, PC, previous radiotherapy, and secondary AUS placement (P <.05). On multivariate analysis, only PC, radiotherapy, and revision surgery were significant (P <.05), but cuff size and concomitant inflatable penile prosthesis were not associated with AUS cuff erosion.

Conclusion: PC is an independent risk factor for AUS cuff erosion.