Anatomical and Manometric Comparison of Perineal and Transscrotal Approaches to Artificial Urinary Sphincter Placement

Anusionwu, Ifeanyi; Miles-Thomas, Jennifer; Hernandez, David J.; Wright, E. James

doi:10.1016/j.juro.2012.07.032

Cited by 9 publications

(5 citation statements)

References 6 publications

(7 reference statements)

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“…The cuff was most probably implanted by the easier trans-scrotal approach in our subject, the pump itself being placed in the left sub-dartos pouch via the same approach. While some studies advocated the perineal approach [13], the scrotal approach appeared to be satisfactory in our subject. A significant observation was the location of the balloon anterior to the left lower RA muscle, just under the anterior rectus sheath in our subject.…”

Section: Placement Of Ausmentioning

confidence: 58%

“…These sites can be accessed through the trans-scrotal incision. These balloon placement sites also generate a higher urethral RLPP during cuff inflation, providing better urinary continence because most patients are post-prostatectomy cases afflicted with stress urinary incontinence (SUI) [2,3,12,13]. It is our postulate, which we shall elaborate subsequently, that our subject perhaps did not require high urethral RLPP, which may have explained the balloon placement in his left lower anterior abdominal wall.…”

Section: Placement Of Ausmentioning

confidence: 83%

“…The normal appearance of the bladder and ureters leads us to speculate that obstructive uropathy was not a significant factor in our subject. Since the UI was not postoperative, an anterior abdominal wall balloon implant may have been sufficient in our subject [2,3,12,13]. Finally, the complex hemodynamic alterations resulting from his unique situation cumulatively compromised his cardiac status to the final end-of-life state (Figure 11).…”

Section: Clinicopathological Reconciliationmentioning

confidence: 98%

“…An extensive literature search revealed seven AUS studies on human cadavers, ours being the eighth. The first report in 2012 compared perineal and trans-scrotal approaches for urethral cuff placement and concluded that though the latter was technically easier, the perineal approach offered better urethral size, the proximity of placement, and urethral coaptation as measured by urethral retrograde leak point pressure (RLPP) [13]. The second report in 2015 tested the feasibility of a newer ARTUS™ device (Affluent Medical, Paris, France) on cadavers [2].…”

Section: Aus Cadaver Studiesmentioning

confidence: 99%

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Artificial Urinary Sphincter With Bilateral Atrophic Kidneys and Accessory Renal Arteries in a Male Cadaveric Subject: A Case Report and Clinicopathological Reconciliation of Urinary Abnormalities and Embryogenetic Correlation of Vascular Aberrations

Sanyal¹,

Chunilall²,

Uzoekwe³

et al. 2023

Cureus

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A unique combination of triple abnormality in a willed male body donor dissection, with putative clinicopathological correlations during the subject's lifetime, is described in this case report. The subject had a three-piece artificial urinary sphincter surgically implanted around the proximal corpus spongiosum, left scrotal pouch and in the lower left abdominal wall, ostensibly for urinary incontinence during his lifetime, though the etiology of the latter was not immediately obvious. He also had a total of three accessory renal arteries involving both sides, complicated by bilateral diffuse renal atrophy from presumable glomerulosclerosis or nephrosclerosis-induced nephrotic syndrome. While each entity may not be so unique per se, each is not too common either. The combination of all three findings has not been described to date in the contemporary literature in a single male cadaver dissection. Only seven reports of artificial urinary sphincter studies on human cadaver subjects could be detected in contemporary literature, this being the eighth. Finally, there were no apparent etiopathological or pathogenetic mechanisms to explain the occurrence of each or the coexistence of all of them in a single male cadaveric subject. The artificial urinary sphincter was reviewed with respect to its characteristics, placement, and efficacy. An attempt was made to establish the cause-effect relationship between the artificial sphincter and urinary incontinence that necessitated the implant. Thereafter, a clinicopathological correlation was proposed in this case report to reconcile the concomitance of urinary incontinence, bilateral accessory renal arteries, and bilateral renal atrophy. An embryogenetic mechanism of the aberrant renal arteries was also suggested. Physician awareness from the standpoint of preoperative investigation of such cases was also highlighted.

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Section: Placement Of Ausmentioning

confidence: 58%

Section: Placement Of Ausmentioning

confidence: 83%

Section: Clinicopathological Reconciliationmentioning

confidence: 98%

Section: Aus Cadaver Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Artificial Urinary Sphincter With Bilateral Atrophic Kidneys and Accessory Renal Arteries in a Male Cadaveric Subject: A Case Report and Clinicopathological Reconciliation of Urinary Abnormalities and Embryogenetic Correlation of Vascular Aberrations

Sanyal¹,

Chunilall²,

Uzoekwe³

et al. 2023

Cureus

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show abstract

“…Overall, operative time is reduced, and this also allows for easier implantation of concomitant PP placement. However, outcomes with regards to continence rates, device infection or erosion rates are still controversial (17)(18)(19)(20). At this time, we still perform the traditional two-incision approach for AUS placement.…”

Section: Discussionmentioning

confidence: 99%

Characterizing the biofilm of artificial urinary sphincters (AUS)

Leong¹,

Ancira²,

Bulafka³

et al. 2023

Transl Androl Urol

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Background: There is a paucity of data regarding the bacterial colonization on artificial urinary sphincter (AUS) devices following revision surgery. We aim to evaluate the microbial compositions of explanted AUS devices identified on standard culture at our institution.Methods: Twenty-three AUS devices explanted were included in this study. During revision surgery, aerobic and anaerobic culture swabs are taken from the implant, capsule, fluid surrounding the device, and biofilm, if present. Culture specimens are sent to the hospital laboratory for routine culture evaluation immediately upon case completion. Differences in number of microorganism species detected across samples (richness) against demographic variables were determined through backwards selection of all variables using analysis of variance (ANOVA). We assessed the prevalence (how many times each species occurred) of microbial culture species. Statistical analyses were performed using the statistical package in R (version 4.2.1).Results: Cultures reported positive results in 20 (87%) cases. Coagulase-negative staphylococci were the most commonly identified bacteria among explanted AUS devices (n=16, 80%). Among two of the four infected/eroded implants, more virulent organisms such as Escherichia coli and fungal species such as Candida albicans were identified. The mean number of species identified amongst culture positive devices was 2.15±0.49. The number of unique bacteria identified per sample was not significantly associated with demographic variables including race, ethnicity, age at revision, smoking history, duration of implantation, etiology for explantation, and concomitant medical comorbidities. Conclusions:The majority of AUS devices removed for non-infectious reasons harbor organisms on traditional culture at the time of explantation. The most commonly identified bacteria in this setting is coagulase-negative staphylococci, which may be a result of bacterial colonization introduced at the time of implant. Conversely, infected implants may harbor microorganisms with higher virulence including fungal elements. Bacterial colonization or biofilm formation on implants may not necessarily equate to clinically infected devices. Future studies with more sophisticated technology, such as next-generation sequencing or extended cultures, may evaluate microbial compositions of biofilm at a more granular level to understand its role in device infections.

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Dual Implantation of Inflatable Penile Prosthesis and Artificial Urinary Sphincter or Male Sling: Benefits and Risks

Loh-Doyle

Martins

Boyd

2019

Textbook of Male Genitourethral Reconstruction

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Anatomical and Manometric Comparison of Perineal and Transscrotal Approaches to Artificial Urinary Sphincter Placement

Cited by 9 publications

References 6 publications

Artificial Urinary Sphincter With Bilateral Atrophic Kidneys and Accessory Renal Arteries in a Male Cadaveric Subject: A Case Report and Clinicopathological Reconciliation of Urinary Abnormalities and Embryogenetic Correlation of Vascular Aberrations

Artificial Urinary Sphincter With Bilateral Atrophic Kidneys and Accessory Renal Arteries in a Male Cadaveric Subject: A Case Report and Clinicopathological Reconciliation of Urinary Abnormalities and Embryogenetic Correlation of Vascular Aberrations

Characterizing the biofilm of artificial urinary sphincters (AUS)

Dual Implantation of Inflatable Penile Prosthesis and Artificial Urinary Sphincter or Male Sling: Benefits and Risks

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