Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement

Vol. 44 (2): 355-361, March – Abril, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0097


Cooper R. Benson 1, Hajar I. Ayoub 1, O. Lenaine Westney 2
1 University of Texas Health Science Center At Houston McGovern Medical School, USA; 2 University of Texas MD Anderson Cancer Center, USA



Purpose: We present a novel AUS implantation technique using a single perineal inci­sion for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy.

Materials and Methods: We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simulta­neous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model.

Results: The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported uti­lizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications.

Conclusions: We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

Keywords: Urinary Incontinence, Stress; Urinary Sphincter, Artificial; Prostatic Neoplasms

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