(066) Delayed Removal of the Non-infected Artificial Urinary Sphincter Has Comparable Outcomes to Immediate Removal

Abstract Introduction Urethral cuff erosion is a well described complication of artificial urinary sphincter (AUS) with reported rates of 2 to 18 percent. Current guidelines recommend prompt removal of the device upon erosion diagnosis. Objective This study examines the short- and long-term outcomes of delayed versus immediate removal of non-infected AUS erosions. Methods We reviewed our prospectively maintained AUS QI database from 2011 to 2024 and identified patients who underwent AUS removal for confirmed erosions via cystoscopy. Patients with suspected device infection, defined by SIRS criteria or symptoms like fevers >101.5F, erythema, or scrotal swelling, were excluded. Patients were divided into two groups: immediate removal (IR) within 24 hours and delayed removal (DR) beyond 24 hours from diagnosis. The DR pathway included device deactivation, broad-spectrum antibiotics, and outpatient removal within a week. Outcomes were compared using Pearson’s Chi-squared test. Results Among the 1104 implanted AUS devices, 110 patients had erosions. 90 met inclusion criteria (42 IR, 48 DR). Baseline clinical characteristics were not statistically different. Common risk factors included prior erosion (30% IR vs 25% DR), prior radiation (74% IR vs 69% DR), and posterior urethral stenosis (30% IR vs 20% DR). The mean device age at erosion was 23.75 months (1-108) for IR and 30 months (2-106) for the DR group. The mean time to AUS removal was 4 hours (7-24) in the IR and 5 days (1-23) in the DR group. Complications included persistent extravasation of contrast during retrograde urethrogram (30% IR, 33% DR, OR 1.12, CI 95% 0.46-2.71) and urethral stricture formation (IR 33%, 24% DR, OR 0.67 CI 95% 0.27-1.67) (Table 1). Urethrocutaneous fistulas were seen in two IR and one DR patient. One patient per group developed pubic osteomyelitis. At median follow of 357 (162,3081) days, there was no significant difference in overall complications between IR vs DR (OR 2.82, CI 95% 0.47-1.16, p-value= 0.09). Conclusions Contrary to the classic belief of the need for immediate removal of non-infected AUS erosions, delayed management has similar outcomes to immediate AUS removal. These findings are important for patient counseling and clinical decision making in the AUS patient. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific Corporation Clarification: Industry funding only - investigator initiated and executed study