A 65-year-old male patient underwent robotic assisted laparoscopic radical prostatectomy and lymph node dissection for multi-focal Gleason 4+4 and 4+5 prostate cancer diagnosed by prostate needle biopsy prompted by a surveillance PSA level of 10 ng/mL. The patient had hypertension that was well managed on 5 mg of amlodipine daily, but was otherwise healthy. Final pathology revealed disease completely limited to the prostate without extracapsular extension and nodal involvement.
On follow-up 18 months later, his PSA level was undetectable and he had no evidence of disease recurrence. Since the operation, however, he has experienced severe stress urinary incontinence (SUI). He has had minimal improvement of his incontinence and requires 4 to 6 heavy pads per day.
Due to the severity of his SUI, he underwent placement of an artificial urinary sphincter (AUS). The AUS was working well for him, but about 3 months after AUS placement he was in a motor vehicle accident and presented to a trauma center unconscious and with severe injuries. During this time, he had a 16Fr Foley catheter placed without deactivation of the AUS.
Three months later, he recovered fully from his injuries but has had recurrent urinary tract infections, dysuria, worsening incontinence, occasional hematuria, and difficulty cycling his AUS. Cystoscopy revealed evidence of cuff erosion.
The case was prepared by Kai B. Dallas, MD, Fellow, Female Pelvic Medicine and Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles.