Urethral Diverticula Following Explanation of Artificial Urinary Sphincter

Introduction: Urethral erosion accounts for one of the most dreaded complications after implantations of artificial sphincters. We report two cases involving urethral diverticula, as a result of prosthetic removal caused by urethral erosion. Case Report: Case A: BG, patient aged 72, affected by urinary incontinence post-radical prostatectomy. In 1999 the patient had an implant of artificial sphincter and recovered fully continence. In 2006 the cuff was replaced due to relapsing urinary incontinence. After five months the patient was diagnosed urethral erosion and was thus subject to surgical removal of the sphincter and application of a bladder catheter for a period of 4 weeks. After 6 months, voiding cysto-urethrography showed a bulky urethral diverticulum, surgically removed, suturing the urethral injury. Case B: PF, aged 71, affected by urinary incontinence after endoscopic treatment of a stenosis of the bladder-urethral anastomosis. In July 2000 an AMS 800 was implanted and continence was recovered. In February 2009 the patient experienced recurrent urinary incontinence due to malfunctioning of the apparatus. The sphincter was thus removed and a new one was implanted in the same operation. In March 2012 the patient was diagnosed urethral erosion and subject to removal of the device. 3 months later a voiding cysto-urethrography showed a bulky diverticulum of the urethra originating from the organ. Conclusions: Urethral erosion is a dreaded complication of the implant of AMS800 device. Its occurrence does not prevent a possible re-implantation, in extremely motivated patients, but exposes the same to a greater risk of infections and erosions, and possible formation of urethral pseudo-diverticula requiring complete removal of the diverticulum sac and concurrent perineum restoration of the urethra. In our opinion these patients are no longer eligible for urethral prosthetic surgery and the poor trophic conditions of the urethra could make any other approach, even a mini invasive one, inadvisable.