Presentation Authors: Yooni Yi*, Joceline Fuchs, Michael Davenport, Maxim McKibben, Allen Morey, Dallas, TX
Introduction: Urethral injury during inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS) placement is rare, and traditionally most prosthetic surgeons avoid or abort prosthetic implantation when urethral repair is necessary. We report our experience with synchronous urethroplasty (SU) as a planned or damage control surgery during urologic prosthetic surgery to determine the safety and outcomes.
Methods: A retrospective review of our extensive IPP and AUS database was completed to identify patients who underwent a synchronous urethroplasty from 2007 to 2018. We included patients who underwent SU during prosthetic surgery due to either (a) planned setting for known stricture or diverticulum, or (b) damage control setting after injury. Patient comorbidities and prior prosthetic or urethral surgeries were assessed. The follow-up was based on the most recent visit available upon chart review. Success was defined as the absence of urethral stricture and revision surgery.
Results: From our database of 1508 prosthetic cases, we identified 7 patients (0.46%) who had an SU in the same setting as complete prosthesis placement (4 AUS, 3 IPP [1 combined IPP/AUS], 1 sling). Three patients had a planned repair of a urethral abnormality, and four patients had repair of an intraoperative urethral injury. Among planned repairs, the abnormalities included a urethral diverticulum, urethrocutaneous fistula and a pre-existing urethral stricture of unknown etiology. In the patients who had an intraoperative urethral injury, etiologies were prior anti-continence surgery with significant scarring (n=2), severe corporal fibrosis, and prior urethral disruption from pelvic fracture. Six of the urethroplasties were completed with a primary closure while one patient underwent a dorsal and ventral graft procedure. Suprapubic tube (SPT) catheters were utilized in 6 out of 7 patients with average indwelling time of 4.1 weeks (7 to 47 days). The average follow-up was 21.5 months and all patients were continent at follow-up. There were no infectious or urethral complications identified. One patient had a revision of their AUS with downsizing of their cuff 13 months from the surgery.
Conclusions: Synchronous urethroplasty with prolonged suprapubic tube urinary diversion offers a safe â€œdamage controlâ€ approach for men with urethral pathology during prosthetic surgery without conferring an increased infection or stricture risk.