Penoscrotal incision for primary implant AMS 800 artificial urinary sphincter

Koenraad van Renterghem1
1: Jessa hospital and University Hospitals Leuven

Introduction: Nearly all artificial urinary sphincter implants are done by a two incision perineal-inguinal approach. In this video we demonstrate the single incision technique with a transverse penoscrotal approach. This approach allows excellent exposure, adequate placement of the cuff and quicker surgery with subsequent less infection risk.
Case presentation: In this video we operate a 77 year old male patient. Nine years ago he had a inguinal hernia repair on the left side. Eighteen months ago he underwent a radical retropubic prostatectomy for a T2c G3 N0 M0 prostate cancer with gleason 4 + 5 = 9/10. He had pelvic floor muscle training however severe incontinence persisted needing > 5 pads/day.
Discussion: Since most of penile implant surgery is nowadays achieved by a penoscrotal approach, the same incision should be considered for implant of artificial urinary sphincter surgery. Knowing that infection is the most feared complication of prosthetic surgery and knowing that infection risk is related to either operating time as well as number of incisions, penoscrotal approach is an attractive alternative for this kind of surgery. Furthermore in literature there is evidence of a same functional outcome.