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

Abstract

PurposeWe 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 MethodsWe 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.ResultsThe 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.ConclusionsWe 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.

Single perineal incision for artificial urinary sphincter: analysis of technique, outcomes, and experience

“…AUS placement remains the gold standard for post- prostatectomy incontinence patients (1). Traditional studies have illustrated the use of a counter-incision for PRB placement, and only a few small series have described a single perineal incision approach to AUS placement (9). This study represents the largest series to our knowledge utilizing this novel approach and highlights its feasibility and practicality as an alternative method of AUS placement, with comparable complication rates, and provides excellent cosmetic results with no visible groin incisions.…”

“…In this study, we propose a novel and accessible single perineal incision technique that may be less morbid and has been used at our center for many years as only a few small series have been published on this technique (9).…”