Abstract
ABSTRACTPurposeWe present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy.Materials and MethodsWe retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model.ResultsThe mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications.ConclusionsWe present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.
Highlights
The primary goal in the management of urinary incontinence and erectile dysfunction related to the treatment of prostate cancer is the improvement of long-term quality of life of our patients
We demonstrate the feasibility of a single perineal incision placement of an artificial urinary sphincter (AUS)
We performed a retrospective review of six patients with stress urinary incontinence undergoing AUS placement through a single perineal incision performed by a single surgeon (OLW) between June 2014 and December 2014 at MD Anderson Cancer Center
Summary
The primary goal in the management of urinary incontinence and erectile dysfunction related to the treatment of prostate cancer is the improvement of long-term quality of life of our patients. The technique for the implantation of the AUS device utilizes two incisions: a perineal and an inguinal incision This allows for bulbar urethral placement of the cuff and a retropubic location for the pressure regulating balloon (PRB) into the space of Retzius by piercing transversalis fascia [4]. Wilson and Delk described ‘ectopic’ placement of the PRB between transversalis fascia and rectus muscles, which would avoid potential problems placing the PRB in the space of Retzius [6]. Wherein they describe ectopic placement of the PRB from both transverse scrotal and perineal approaches [6]. Ectopic placement avoids the potential hazards of placement into a previously operated field or radiated retropubic space, including injury or obstruction to surrounding vasculature or organs (intestines, bladder, ureter)
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