Abstract
ABSTRACT
Introduction
Artificial urinary sphincter implantation is guideline‐supported for post‐prostatectomy stress urinary incontinence; however, ultra‐late urethral deterioration remains poorly characterized.
Case Presentation
A 66‐year‐old man underwent radical retropubic prostatectomy in December 2006, followed by salvage radiotherapy in April 2007. Twelve years after artificial urinary sphincter implantation, intraluminal cuff exposure was incidentally detected on cystoscopy before urethral catheterization for orthopedic surgery. Urinalysis at diagnosis and pre‐explant urine culture were unremarkable. Explantation was delayed for 5 months because of patient preference after counseling about infection and urethral injury risks. At explantation, the bulbar urethra showed near‐obliterative circumferential collapse with loss of architecture, requiring excision and primary anastomosis urethroplasty (EPA). Obstructive symptoms recurred within 2 months, and recurrent stricture was confirmed endoscopically; suprapubic cystostomy was required at 3 months.
Conclusion
This case demonstrates ultra‐late advanced urethral deterioration beyond focal cuff erosion or simple atrophy. In high‐risk radiated patients, explantation may not restore urethral integrity.