Unbuckling: an answer to address cuff-related challenges in urethral instrumentation with an artificial urinary sphincter

Hasan Jhaveri^*, Mariela Martinez-Rivera, Brent Nose, Jordan Foreman, Aaron C. Lentz
Department of Urology, Duke University School of Medicine, 40 Duke Medicine Cir, Durham, NC 27710, USA
* Corresponding Author: Hasan Jhaveri. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.068095

Received 21 May 2025; Accepted 04 August 2025; Published online 19 September 2025

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Abstract

Objectives: There is limited in vivo data on the maximum safe instrument size that can be passed through an artificial urinary sphincter (AUS) cuff. While 21 French instruments are generally safe with the commonly used 4.5 cm cuff, larger instruments or smaller cuffs may require unbuckling to avoid urethral erosion. This study aimed to identify if artificial urinary sphincter cuff ‘unbuckling’ affects device longevity and risk of erosion. Methods: A retrospective study of patients at a quaternary health system who underwent unbuckling was conducted. Using the Epic Clarity database and Duke Enterprise Data Unified Content Explorer (DEDUCE), we identified patients with artificial urinary sphincter (AUS) who were unbuckled during endoscopic procedures. Descriptive statistics were used to analyze patient demographics, device age at unbuckling, complications, and history of erosion, removal, or replacement. Results: Eight patients were identified with a prior history of AUS unbuckling. The average age was 68 years. 75% of patients had a history of pelvic radiation. The average number of unbuckling procedures per patient was 1.62. The median device age at first unbuckling was 2.60 years. Average time to reactivation was 22.25 days, and 6 of 8 patients had their device reactivated. Two patients developed erosions requiring device removal. Neither erosion occurred within 90 days of unbuckling. The mean age of devices at the time of removal was 6.85 years. Conclusions: AUS cuff unbuckling may serve as an alternative strategy when large-caliber urethral instrumentation is required. Studies with larger patient cohorts are required to further investigate the efficacy and ideal utilization of unbuckling.