Perineal Approach for Artificial Urinary Sphincter Implantation

Title: Perineal Approach for Artificial Urinary Sphincter Implantation

Author: K.M.L.E. van Renterghem, M.D. Ph.D. FEBU
Jessa Hospital Hasselt, University Hospitals Leuven, Hasselt University, Belgium

Artificial Urinary Sphincter (AUS) implantation should be considered the best surgical option for severe Stress Urinary Incontinence (SUI) in male patients. In 1972, Scott implanted the first AUS (AS 721), since that time AUS implantation became progressively a common procedure in prosthetic urological surgery.  From the beginning, the perineal approach was the classical surgical technique, consisting in a perineal incision for cuff placement and a second inguinal/abdominal incision for reservoir placement. Yafi et al. (1) showed in a recent review article that AUS is an effective treatment for SUI, however familiarity with this kind of surgery is obligatory with regard to success and outcome of these procedures.

Also in the long range, AUS implantation is an effective treatment modality. Leon et al. (2) showed in a recent paper that even after 10 years or more, AUS offers a high rate of continence in men with severe SUI.

Patients who underwent previous external radiotherapy, as the patient in this video, should be explained pre-operatively complication rates are higher compared with the non-irradiated patient. Especially infection and explantation rates are higher in this particular subgroup (3), on the other hand, continence rates are similar.

  1. Yafi et al: Contemporary review of artificial urinary sphincters for male stress urinary incontinence. Sex Med Rev 2016 Apr;4(2):157-166
  2. Léon et al: Long-term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence. BJU Int. 2015 Jun;115(6):951-7
  3. Ravier et al: Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy. BJU Int. 2015 Feb;115(2):300-7