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Vol. 42. Issue 3.
Pages 202-206 (April 2018)
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Vol. 42. Issue 3.
Pages 202-206 (April 2018)
New Techniques and Technologies
Management of iatrogenic cystoscopic urethral lesion associated with sequela of cuff erosion in a patient after previous AMS 800 implantation. One-step technique with revision, without cuff explantation
Tratamiento de la lesión uretral cistoscópica iatrogénica asociada a secuela de la erosión del manguito en un paciente después de la implantación previa de AMS 800. Técnica de un solo paso con revisión, sin explantación del manguito
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P. Weibl
Corresponding author
pweibl@yahoo.com

Corresponding author.
, M. Rutkowski, W. Huebner
Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Korneuburg, Austria
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Abstract
Introduction

Iatrogenic urethral lesion with subsequent cuff erosion during cystoscopy is a rare complication. The alternative surgical strategy with in situ urethroplasty while maintaining the open cuff left in situ will be presented.

Materials and methods

The authors report 3 cases of iatrogenic urethral lesion with cuff erosion during cystoscopic evaluation to exclude stricture or cuff erosion due to new onset of obstructive lower urinary tract symptoms. All patients had a history of a AMS 800 implantation due to postprostatectomy incontinence. Rigid cystoscopy was performed, which revealed no pathologies; however, iatrogenic small urethral lesion was identified during the removal of the cystoscope at the projection of the cuff.

Results

In situ urethroplasty was performed, and the cuff was left open in situ. Additionally a protection fat flap was placed around the urethra from the dorsolateral aspect, separating the cuff and urethra from the direct contact with each other. After 6 weeks the urethral defect was completely healed and via a primary perineal incision the cuff was readapted and closed. The device was fully functioning without any additional adjustments.

Conclusion

Our modification should be considered in select cases with absence of infection as part of management strategy for cases of iatrogenic urethral lesions with subsequent cuff erosion. Thereby the original cuff can be spared and the possibly difficult preparation of the urethra during reoperation can be avoided. However, additional more cases should be presented in the worldwide literature, to confirm the utility of this surgical principle.

Keywords:
Urinary incontinence
Urethroplasty
Cuff erosion
Resumen
Introducción

La lesión uretral iatrogénica con posterior erosión del manguito durante la cistoscopia es una complicación poco frecuente. Se presentará la estrategia quirúrgica alternativa con uretroplastia in situ manteniendo el manguito abierto in situ.

Materiales y métodos

Los autores describen 3casos de lesión uretral iatrogénica con erosión del manguito durante la evaluación cistoscópica para excluir la estenosis o la erosión del manguito debido a la reaparición de síntomas obstructivos del tracto urinario inferior. Todos los pacientes tenían antecedentes de implantación de AMS 800 por incontinencia posprostatectomía. Se realizó una cistoscopia rígida, que no reveló alteraciones; sin embargo, se identificó una pequeña lesión uretral iatrogénica durante la extirpación del cistoscopio en la proyección del manguito.

Resultados

Se realizó uretroplastia in situ y el manguito se dejó abierto in situ. Además, se colocó una solapa de grasa protectora alrededor de la uretra desde la cara dorsolateral, separando el manguito y la uretra del contacto directo entre sí. Después de 6 semanas el defecto uretral se curó completamente y a través de una incisión perineal primaria el manguito fue readaptado y cerrado. El dispositivo estaba funcionando sin ningún ajuste adicional.

Conclusión

Nuestra modificación debe considerarse, en casos seleccionados sin infección, como parte de la estrategia de tratamiento en los casos de lesiones uretrales iatrogénicas con posterior erosión del manguito. De esta manera se puede evitar el manguito original y la preparación posiblemente difícil de la uretra durante la reoperación. Sin embargo, se deben presentar más casos en la literatura mundial para confirmar la utilidad de este principio quirúrgico.

Palabras clave:
Incontinencia urinaria
Uretroplastia
Erosión del manguito

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