PD29-03 MODIFIED TRANSCORPORAL CUFF PLACEMENT IN COMPLEX ARTIFICIAL URINARY SPHINCTER IMPLANTS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2017PD29-03 MODIFIED TRANSCORPORAL CUFF PLACEMENT IN COMPLEX ARTIFICIAL URINARY SPHINCTER IMPLANTS André Cavalcanti, Carlos Felipe Restreppo, Henrique Florindo, Roberto Medeiros, Túlio Rojas, and Neildo Chaves André CavalcantiAndré Cavalcanti More articles by this author , Carlos Felipe RestreppoCarlos Felipe Restreppo More articles by this author , Henrique FlorindoHenrique Florindo More articles by this author , Roberto MedeirosRoberto Medeiros More articles by this author , Túlio RojasTúlio Rojas More articles by this author , and Neildo ChavesNeildo Chaves More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1355AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The transcorporal (TC) artificial urinary sphincter (AUS) cuff placement was first described in 2002 for cases requiring revision for erosion and urethral atrophy. A distal cuff location is often required in patients undergoing artificial urinary sphincter re-implantation after previous erosion or in those requiring revision because of urethral atrophy at the original cuff site. Dissecting the urethra at a more distal site increases the risk of urethral injury and erosion, and often the urethral circumference is so small. A distal cuff placement using TC dissection that leaves corporal tunica albuginea on the dorsal surface of the urethra, allowing for its safer mobilization and adding to its bulk. We present a technical modification on the TC AUS cuff placement based on the use of local tunica albuginea flaps. METHODS The charts of 11 patients submitted to a modified TC cuff placement during a period of 7 years were analysed. The age of the patients ranged from 53 to 81 years (mean of 69 years). The initial approach to the distal urethral and corporal bodies is similar to the classic TC approach. The two bilateral vertical incisions, on each side of the urethra, was modified for a creation of two bilateral tunica albuginea flaps with a rectangular shape. Those flaps are mobilized medially to cover the lateral and ventral portions of the urethra. As on the classic TC approach the corporal septum was opened to create a space to the cuff placement. The tunica albuginea gap created by the flaps mobilization was closed with grafts or treated with glues. A 5.0 cuff was used in 2 cases, a 5.5 cuff in 6 cases and a 6.0 cuff in 3 cases. The modified TC cuff placement was used in 5/11 patients with a history of urethroplasty (4/5 irradiated patients), in 2/11 patients with a history of radiotherapy to treat prostate cancer, in 4/11 patients with a history of previous erosion/infection AUS implants ( 1 or 2 surgeries). RESULTS After a mean follow up of 27,3 months, the rate of implant explantation was 27% (2 associated to cuff erosion and 1 to infection without erosion). 7/11 (63,6%) were using 1 pad or less. A temporary retention was observed in 5/11 patients (45,5%). In 5/11 patients (45,5%) a staged implant was performed. In 3 patients, the cuff was placed on the first procedure and the PRB balloon/cuff on the second procedure. In 2 patients we used a silicone tape was implanted on the first procedure and the AUS implanted on a second procedure. CONCLUSIONS The modified TC AUS cuff placement is an safe and viable technique and could be used as part of the technical armamentarium to deal with complex AUS implants. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e572-e573 Advertisement Copyright & Permissions© 2017MetricsAuthor Information André Cavalcanti More articles by this author Carlos Felipe Restreppo More articles by this author Henrique Florindo More articles by this author Roberto Medeiros More articles by this author Túlio Rojas More articles by this author Neildo Chaves More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...