Extensive Dystrophic Calcification of Eroded Artificial Urinary Sphincter Cuff

A Rare Cause of Urethral Obstruction: A Case Report

Kevin C. Lewis; Scott D. Lundy; Kenneth Angermeier

Disclosures

Transl Androl Urol. 2022;11(4):567-570. 

In This Article

Abstract and Introduction

Abstract

Background: Despite a high technical success rate and satisfaction, complications of an artificial urinary sphincter (AUS) can occasionally occur and vary in severity from transient urinary retention to unrecognized urethral injury or urethral erosion. Infection usually occurs when urine comes into contact with the device and necessitates explant of the cuff followed by delayed device replacement. In rare cases, however, the device can remain in contact with urine for long periods of time without the sequelae normally associated with acute infection.

Case Description: Here we present a case report of two patients with intraurethral migration of AUS cuffs associated with calcification resulting in urethral obstruction precluding catheterization. With extensive calcification around the cuff and longstanding complete erosion into the urethra, the urologist can expect obliteration of normal tissue planes and intense fibrosis during cuff explantation. Following excision of the cuff and stones, assessment of the urethral lumen should be performed to determine whether repair of the urethra is required. After surgery, urinary diversion with a urethral catheter is important to allow for urethral healing. Prior to considering AUS replacement, cystoscopic assessment of the urethra is critical to assess for stricture or other abnormality.

Conclusions: Extensive calcification following AUS erosion into the urethra requires the expertise of a urologist with experience in urethral surgery in order to optimize outcomes. Urologists should be aware of this uncommon, but dramatic presentation of urethral obstruction due to a chronically eroded AUS cuff.

Introduction

Complications from an artificial urinary sphincter (AUS) include urinary retention (31%), superficial skin infection (1%), device infection (6%), urethral atrophy (9.6–11.4%), and urethral erosion (3.8–10%).[1] If urethral atrophy goes unmanaged, the cuff may erode through the urethra. Early cuff erosion is often due to urethral injury during implantation, whereas late erosion is more often due to trauma to the cuff.[1] In the absence of acute infectious symptoms, chronic erosion may result in extensive dystrophic calcification causing urethral obstruction, urinary retention, and space-filling stone debris precluding catheterization. We present the following article in accordance with the CARE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-21-709/rc).

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