Delayed management of artificial urinary sphincter cuff erosion

Background: The artificial urinary sphincter (AUS) has been used to treat post-prostatectomy incontinence in men for decades with excellent outcomes and low complication rates. A successful AUS placement can dramatically improve the quality of life in men with stress urinary incontinence. Consequently, complications in this population can be devastating for the patient. One of the most troublesome complications is cuff erosion, which necessitates explantation of the device and dooms a man to recurrent incontinence. While the device can be replaced, device replacements are fraught with high erosion rates. Furthermore, it is not uncommon for men undergoing AUS placement to have multiple medical comorbidities that make urgent surgery for explantation unideal. Nonetheless, men with cellulitis and significant symptoms must undergo removal of an eroded AUS. There is little to no literature published on the timing or need for device removal in the man who has an asymptomatic erosion. Case Description: We report a case series of five men undergoing delayed or no explantation of an asymptomatic cuff erosion. All five men were asymptomatic at the time of presentation and underwent a delayed explant or no explant. No man required urgent device explant while the erosion was present. Conclusions: Urgent device explantation may not be necessary in the asymptomatic AUS cuff erosion, and further study may be able to elucidate men who can avoid removal of cuff erosion when no symptoms are present.