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. 2020 Oct;9(5):1912-1919.
doi: 10.21037/tau-20-508.

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

Nahid Punjani  1   2 , Ernest Chan  2 , Garson Chan  2 , Haider Abed  2 , Jeffrey Campbell  2 , Gerald Brock  2
Affiliations

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

Nahid Punjani et al. Transl Androl Urol. 2020 Oct.

Abstract

Background: To describe a large series of male patients who underwent a minimally invasive single perineal incision artificial urinary sphincter (AUS) placement in patients with stress urinary incontinence.

Methods: A retrospective cohort study was performed with data collected from men undergoing AUS placement by a single high-volume surgeon over a 12-year period (2005 to 2017). Demographic and outcomes data related to AUS placement were recorded from electronic medical records, which included subjective histories and questionnaires. Institutional ethics approval was received.

Results: A total of 145 AUS were placed over the study period. Of these, 84 were performed through a single perineal incision for both device and reservoir placement. Almost all (n=81, 96%) reported pre-operative incontinence of more than 3 pads per day. Postoperatively, 75% were satisfied with their continence, with 21 (25%) complaining of recurrent incontinence. A total of 5 (6%) patients developed a post-operative infection, 10 (12%) had device erosion and 11 (13%) had device malfunction, but only 3 (4%) had reservoir dysfunction. A total of 24 (29%) patients required revision of their device at median of 20 months (IQR, 6-32.5 months).

Conclusions: Single perineal incision is a feasible, safe, and potentially superior approach for AUS placement and warrants consideration as an accepted approach due to its more rapid surgical times, lower morbidity related to a single incision with minimal fascial defect, and favorable complication rates.

Keywords: Artificial urinary sphincter (AUS); post-prostatectomy incontinence (PPI); single incision.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau-20-508). GB serves as an unpaid editorial board member of Translational Lung Cancer Research from Mar 2018 to Feb 2020. GB reports other from Boston Scientific, Eli Lilly, Acerus Pharma, Pfizer, Paladin, Merck, Upjohn, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Depiction of access using surgeon’s finger into the retropubic space for reservoir placement behind the transversalis fascia.
Figure 2
Figure 2
Illustration highlighting pump and pressure regulating balloon tubing from a single perineal incision (3–5 cm).
Figure 3
Figure 3
Illustration demonstrating the location of the reservoir behind the pubic bone and transversalis fascia, as well as the device cuff around the urethra and pump in the dependent portion of the scrotum.
See this image and copyright information in PMC

Comment in

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