Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Int Braz J Urol. 2022 Jul-Aug;48(4):679-685. doi: 10.1590/S1677-5538.IBJU.2022.0089.
To characterize the most common presentation and clinical risk factors for artificial urinary sphincter (AUS) cuff erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these patients.
We retrospectively reviewed our tertiary center database to identify men who presented with AUS cuff erosion between 2007 - 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for symptom comparison. Risk factors for cuff erosion - pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) - were recorded for each patient. Presenting signs and symptoms of cuff erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (SI).
Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) sustained cuff erosion. Most erosion patients (40/61, 66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling. Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with SI or obstructive symptoms presented significantly earlier than those with worsening incontinence (SI 14 ± 18 vs. obstructive symptoms 15 ± 16 vs. incontinence 37 ± 48 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n=61), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 49%, p=0.02).
AUS cuff erosion most commonly presents as SI symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.
描述人工尿道括约肌（AUS）袖套侵蚀的最常见表现和临床危险因素，以区分这些患者中应进一步评估的症状的相对频率。
我们回顾性地审查了我们的三级中心数据库，以确定 2007 年至 2020 年间出现 AUS 袖套侵蚀的男性。从同一数据库中随机选择了一组接受 AUS 植入而无侵蚀的男性作为症状比较的相似队列。记录每位患者的袖套侵蚀的危险因素-盆腔放疗、雄激素剥夺治疗（ADT）、高级别前列腺癌（Gleason 评分≥8）。将袖套侵蚀的表现症状分为三类：阻塞症状、失禁恶化和局部阴囊炎症（SI）。
在研究期间，893 名接受 AUS 植入的男性中，有 61 名（6.8%）发生袖套侵蚀。大多数侵蚀患者（40/61，66%）出现阴囊炎症改变，包括触痛、红斑和肿胀。较少的男性报告有阻塞症状（26/61，43%）和失禁恶化（21/61，34%）。有 SI 或阻塞症状的男性比有失禁恶化的男性更早出现症状（SI 14±18 个月 vs. 阻塞症状 15±16 个月 vs. 失禁 37±48 个月，p<0.01）。与非侵蚀对照组（n=61）相比，发生侵蚀的男性盆腔放疗的患病率更高（71% vs. 49%，p=0.02）。
AUS 袖套侵蚀最常见的表现是 SI 症状。阻塞性排尿症状和失禁恶化也很常见。任何这些症状都应提示进一步调查袖套侵蚀。
