Presentation Authors: Urszula Kowalik*, Durham, NC, Arman Kahokehr, Adelaide, Australia, Andrew Peterson, Durham, NC
Introduction: Optimizing sizing of an artificial urinary sphincter (AUS) cuff is of paramount importance for technical success as well as quality of life (QOL) improvement in men with post-prostatectomy incontinence. Correct selection of the size of the artificial urinary sphincter cuff at the time of placement is dependent upon intraoperative measurement of the circumference of the urethra. Currently, there is no consensus on whether it is better to measure the urethra with or without a Foley catheter in place and it is unknown how this affects the chosen cuff size. We hypothesized that urethral circumferential measurement is not altered based on the presence or absence of a Foley catheter.
Methods: We performed a retrospective review of prospectively collected data for purposes of institutional quality improvement. The prospective data was collected on consecutive first-time placement of a trans-perineal AUS from 2015 until 2018. Only men without a history of radiation and without a history of prior male sling or AUS were included. We performed a series of measurements during the procedure - without a catheter, with a 12Fr catheter and finally with a 16Fr catheter. The measurements were made using sterile umbilical tape cut to fit and a ruler. These were recorded, as was the final cuff size. Comparison was made between each measurement and the final cuff size.
Results: Forty-seven patients were included in the analysis. As depicted in table 1, data was analyzed using a Spearman's coefficient revealing significant correlation between each measurement with less than 0.1 mm mean difference (p < 0.0001). The cuff size chosen was between 4 and 5.5 cm with 47% of the cuffs chosen being 4.5 cm. There was no significant difference in the measurements of circumference without a catheter, with a 12 or 16 French catheter in place (p < 0.0001) suggesting that final cuff size was not influenced by the presence or absence of a urethral catheter.
Conclusions: The presence of a urethral catheter does not influence circumferential measurement during AUS implantation. Because of this, we no longer routinely remove the catheter during the measuring portion of the procedure. We feel that minimizing catheter manipulation will potentially translate into decreased complication rates due to decreased length of the procedure and decreased exposure of the implant.