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Urethral Stricture Outcomes after AUS Cuff Erosion: Results from a Multicenter Retrospective Analysis
Martin S. Gross, MD¹, Mario A. Cleves, PhD², Melissa R. Kaufman, MD³, Douglas F. Milam, MD³, Travis W. Dum, MD⁴, Joshua A. Broghammer, MD⁴, William O. Brant, MD⁵, LeRoy A. Jones, MD⁶, Chris McClung, MD⁷, Jeffrey D. Brady, MD⁸, Gerard D. Henry, MD⁹.
¹Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Keene, NH, USA, ²University of Arkansas for Medical Sciences, Little Rock, AR, USA, ³Vanderbilt University Medical Center, Nashville, TN, USA, ⁴University of Kansas Medical Center, Kansas City, KS, USA, ⁵University of Utah Hospital, Salt Lake City, UT, USA, ⁶Urology San Antonio, San Antonio, TX, USA, ⁷Central Ohio Urology Group, Gahanna, OH, USA, ⁸Florida Urology Associates, Orlando, FL, USA, ⁹Regional Urology, Shreveport, LA, USA.

BACKGROUND: There are few studies in the literature regarding patient outcomes after AUS cuff erosion. In this review, seven surgeons from six high-volume male continence centers compiled a comprehensive database of post-erosion patients. The goal was to evaluate the influence of both repair type and degree of cuff erosion on post-operative urethral stricture rate.
METHODS: This is a retrospective multi-institution study of 80 patients who had AUS cuff erosions and underwent subsequent treatment. Seventy-eight patients had specific information regarding post-cuff erosion urethral strictures. Patients underwent one of three types of repair: catheter only, single-layer capsule to capsule repair (urethrorrhaphy), and formal urethroplasty. Patients' operative notes and charts were extensively reviewed to collect study data.
RESULTS: Twenty-five of 78 patients had a urethral stricture after AUS cuff erosion (32.1%). More strictures occurred among patients who underwent urethrorrhaphy repair (39.5% vs. 28.6% for catheter only and 14.3% for urethroplasty), but stricture rates did not vary significantly by repair type (p=0.2). Strictures occurred significantly more frequently in patients with complete cuff erosions (58.3%) as compared to patients with partial erosions (25%, p=0.037, see Figure 1). Patients with partial erosions were more likely to undergo urethrorrhaphy repair (60%, p=0.002). There was no difference in repair type performed on patients with complete erosion. A trend was seen regarding increased percentage of erosion and increased stricture rate, but it did not reach significance (p=0.057). Although only 12 patients had a complete erosion, strictures occurred more frequently among patients with complete erosion that underwent either catheter only repair or urethrorrhaphy (75%), compared to patients that underwent urethroplasty (25%). However, Fisher's exact p-value for this finding was not significant (p = 0.222).
CONCLUSIONS: Urethral stricture was more likely to occur after complete cuff erosion as opposed to partial erosion in this multi-center retrospective population. Repair type, whether catheter only, urethrorrhaphy, or formal urethroplasty, did not appear to influence post-operative stricture rate.

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