The field of urethral reconstructive urology continues to advance itself with innovation in both surgical technique and technology. Industry continues to improve on its devices, (ie, penile implants, slings and artificial sphincters), making them more effective and more durable, minimizing failures. Surgeons spend years training to hone their surgical technique. However, to maximize operative outcomes, the 3 pillars that play a primary role includes not only (i) the surgeon and his/her surgical skill/technique, (ii) the device itself, but also (iii) the patient him(her)self. Particularly when it comes to artificial urethral sphincters, recognized patient factors that can increase the risk for urethral erosion include: history of pelvic radiation (XRT), prior AUS erosion, prior urethral surgeries, history of urethral stents, and medical comorbidities like hypertension and coronary artery disease (CAD).1 In recent years, there is also mounting data in the literature to suggest that testosterone may have a significant role in urethral health and surgical outcomes. In the next few paragraphs, I will briefly review the current evidence I find compelling enough to change how I evaluate and treat my patients in need of urethral surgery.
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