An ongoing management dilemma in urologic prosthetics is how to manage a damaged urethra in cases of eroded artificial urinary sphincter (AUS)[
1]. In these circumstances, the erosion creates a defect in the urethra at the cuff location, and the urologist must decide whether to repair the urethra immediately with urethroplasty or rely on secondary healing over a Foley catheter. Patients with urethral injury are at risk for urethral stricture, urethral fistula, and diverticulum, all of which impact the timing and ability to replace the AUS. In this study, the authors[
2] review their series of patients who underwent immediate or in situ urethroplasty (ISU) at the time of AUS explantation and report their outcomes at a 1‐month follow‐up based on voiding cystourethrogram (VCUG) results. ISU involves suture reapproximation of the urethral capsule rather than a formal urethroplasty with multilayer urethral closure. Their retrospective analysis reviewed 61 patients over 14 years, and they noted that 65.6% of patients healed at 1 month, while 34.4% had persistent contrast extravasation on VCUG. Interestingly, in the variables analyzed, including patient demographics (age, body mass index, diabetes status, hypogonadism, smoking history), operative technique (number of sutures for repair, location of erosion defect, degree or percent erosion), and history of prior radiation, no factor was statistically significant concerning delayed healing. No patient who healed at the 1‐month point developed a urethral fistula, while three patients in the nonhealed group developed a fistula. All patients eventually healed with prolonged catheter drainage. Although 1 month of catheter drainage following explantation of eroded AUS was standard management, after the analysis showing that 34% of patients have delayed healing, the authors now treat their post‐AUS erosion patients with 6 weeks of initial catheter drainage. The limitations of the study are the retrospective nature of the data analysis and the small sample size. However, erosion is infrequent with the AUS device, and large groups of patients for analysis from a single treating center are uncommon. Key takeaways from this paper are that ISU at the time of explantation for eroded AUS is a necessary surgical consideration, and more extended catheter drainage after explantation may result in a more streamlined patient follow‐up process. Future studies should focus on the prospective analysis of different techniques to manage the urethral defect after erosion and the length of indwelling catheter time after AUS explantation.
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