Penoscrotal approach for double cuff in a patient with previous artificial sphincter

Koenraad van Renterghem1
1: Jessa hospital and University Hospitals Leuven


Introduction: In this video we demonstrate the technique of implanting a double cuff of an artificial urinary sphincter in a patient who was previously implanted perineally. We use a single incision penoscrotal approach.
Case presentation: This concerns a 68 year old male patient on coumarin treatment after CVA and aortic valve surgery 8 years ago. Two years ago patient underwent a TURP in another institution ( accidentally finding of prostate cancer – T1b G2 – gleason 3+3=6/10), subsequently in the same institution he underwent a laparoscopic radical prostatectomy ( T2c G2 – gleason 3+3 = 6/10). One year post radical prostatectomy patient underwent in the same hospital a perineal implant of AMS 800 with cuff 4,5 cm with post-operative bleeding needing revision consisting in replacement of the cuff.
Discussion: Whether a double cuff implant results in better continence outcomes and better general surgical outcomes is debatable. For this reason a double implant represents a challenging procedure and should be selected in very well chosen cases. It is of uttermost importance to create an adequate space between the two cuffs of about 1 cm.