V05-07: Transcorporal Artificial Urinary Sphincter Sphincter- The Gullwing Modification
The artificial urinary sphincter (AUS) is most commonly placed in men with non-neurogenic stress urinary incontinence. In the setting of prior urethral compromise, transcorporal AUS placement is often considered. At present, the generally accepted approach has significant limitations in the degree of urethral protection and conservation of corporal capacity for future restoration of sexual health. Therefore, we offer our alternate approach to transcorporal AUS placement, termed the gullwing modification.
In this video, we present a novel technique for transcorporal placement of the AUS, termed the gullwing modification.
After the patient is prepped and draped in the usual sterile fashion, a perineal incision is made and dissection is carried down to the level of the bulbar urethra. Bracket shaped flaps are outlined on the ventral aspect of the tunica albuginea for both flanking segments of corpora cavernosa. These areas are then incised such that flaps can be raised and brought over the ventral urethra. The flaps are then suture approximated to each other using 4-0 Chromic suture. Care is taken to approximate the tissue without tension to avoid urethral compression separate from the AUS cuff. The reinforced urethra is then measured, and a cuff size 0.5 centimeters above measurement is selected to reduce the risk of postoperative urinary retention. Prior to cuff placement, the tunical defect on the ventral corpora cavernosa is measured and covered with a similarly-sized segment of commercially available allograft. The graft is sutured in place with running 4-0 Monocryl suture. After cuff placement, the additional AUS components (pressure regulating balloon, pump) are placed in standard fashion. Flexible cystoscopy is performed while cycling the device to allow visual confirmation of both proper opening and coaptation of the urethra. With the device deactivated, a 12 French silicone catheter is placed per urethra and all incisions are closed in multiple layers of absorbable suture.
The gullwing modification for transcorporal AUS placement allows for circumferential urethral reinforcement with tunica albuginea from the corpora cavernosa. This provides additional support over prior technique descriptions in an attempt to further prevent subsequent cuff erosion. Additionally, corporal grafting avoids the need to compromise the three-dimensional anatomy relevant to future consideration of a penile prosthesis, if desired.