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Urethral Stricture Outcomes after AUS Cuff Erosion: Results from a Multicenter Retrospective Analysis
Martin S. Gross, MD1, Mario A. Cleves, PhD2, Melissa R. Kaufman, MD3, Douglas F. Milam, MD3, Travis W. Dum, MD4, Joshua A. Broghammer, MD4, William O. Brant, MD5, LeRoy A. Jones, MD6, Chris McClung, MD7, Jeffrey D. Brady, MD8, Gerard D. Henry, MD9.
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Keene, NH, USA, 2University of Arkansas for Medical Sciences, Little Rock, AR, USA, 3Vanderbilt University Medical Center, Nashville, TN, USA, 4University of Kansas Medical Center, Kansas City, KS, USA, 5University of Utah Hospital, Salt Lake City, UT, USA, 6Urology San Antonio, San Antonio, TX, USA, 7Central Ohio Urology Group, Gahanna, OH, USA, 8Florida Urology Associates, Orlando, FL, USA, 9Regional Urology, Shreveport, LA, USA.

BACKGROUND: There are few studies in the literature regarding patient outcomes after AUS cuff erosion. In this review, seven surgeons from six high-volume male continence centers compiled a comprehensive database of post-erosion patients. The goal was to evaluate the influence of both repair type and degree of cuff erosion on post-operative urethral stricture rate.
METHODS: This is a retrospective multi-institution study of 80 patients who had AUS cuff erosions and underwent subsequent treatment. Seventy-eight patients had specific information regarding post-cuff erosion urethral strictures. Patients underwent one of three types of repair: catheter only, single-layer capsule to capsule repair (urethrorrhaphy), and formal urethroplasty. Patients' operative notes and charts were extensively reviewed to collect study data.
RESULTS: Twenty-five of 78 patients had a urethral stricture after AUS cuff erosion (32.1%). More strictures occurred among patients who underwent urethrorrhaphy repair (39.5% vs. 28.6% for catheter only and 14.3% for urethroplasty), but stricture rates did not vary significantly by repair type (p=0.2). Strictures occurred significantly more frequently in patients with complete cuff erosions (58.3%) as compared to patients with partial erosions (25%, p=0.037, see Figure 1). Patients with partial erosions were more likely to undergo urethrorrhaphy repair (60%, p=0.002). There was no difference in repair type performed on patients with complete erosion. A trend was seen regarding increased percentage of erosion and increased stricture rate, but it did not reach significance (p=0.057). Although only 12 patients had a complete erosion, strictures occurred more frequently among patients with complete erosion that underwent either catheter only repair or urethrorrhaphy (75%), compared to patients that underwent urethroplasty (25%). However, Fisher's exact p-value for this finding was not significant (p = 0.222).
CONCLUSIONS: Urethral stricture was more likely to occur after complete cuff erosion as opposed to partial erosion in this multi-center retrospective population. Repair type, whether catheter only, urethrorrhaphy, or formal urethroplasty, did not appear to influence post-operative stricture rate.


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