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Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report

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...

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Autores principales: Lewis, Kevin C., Lundy, Scott D., Angermeier, Kenneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9085929/
https://www.ncbi.nlm.nih.gov/pubmed/35558276
http://dx.doi.org/10.21037/tau-21-709
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author Lewis, Kevin C.
Lundy, Scott D.
Angermeier, Kenneth
author_facet Lewis, Kevin C.
Lundy, Scott D.
Angermeier, Kenneth
author_sort Lewis, Kevin C.
collection PubMed
description 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.
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spelling pubmed-90859292022-05-11 Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report Lewis, Kevin C. Lundy, Scott D. Angermeier, Kenneth Transl Androl Urol Case Report 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. AME Publishing Company 2022-04 /pmc/articles/PMC9085929/ /pubmed/35558276 http://dx.doi.org/10.21037/tau-21-709 Text en 2022 Translational Andrology and Urology. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Case Report
Lewis, Kevin C.
Lundy, Scott D.
Angermeier, Kenneth
Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report
title Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report
title_full Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report
title_fullStr Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report
title_full_unstemmed Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report
title_short Extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report
title_sort extensive dystrophic calcification of eroded artificial urinary sphincter cuff—a rare cause of urethral obstruction: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9085929/
https://www.ncbi.nlm.nih.gov/pubmed/35558276
http://dx.doi.org/10.21037/tau-21-709
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