V2-10: Tips and Tricks to Thirty-Minute Artificial Urinary Sphincter Placement

Video

Introductions and Objectives
Artificial urinary sphincter (AUS; AMS 800, American Medical Systems, Minnetonka MN, USA) is a safe and effective treatment modality for treatment of male urinary incontinence. This video demonstrates the key steps in a streamlined approach to AUS placement.

Methods
The patient is positioned in lithotomy stirrups such that the knees are straight when the legs are parallel with the ground. This allows maximum room between the legs for the surgeon and the assistant when the legs are raised. The pressure regulating balloon (PRB) is prepared on the back table by the scrub nurse at the time of urethral dissection. A standard perineal approach is used for bulbar cuff placement. After measuring the circumference of the bulbar urethra, the measuring tape is left around the urethra to allow easy placement of the cuff later in the procedure. The legs are then lowered and a subinguinal approach is used for placement of the pressure regulating balloon (PRB) in the retropubic space. This is less cumbersome than the scrotal or transabdominal approaches for PRB placement. After placement of PRB, the cuff is passed around the urethra using the previously tape as a guide. The tubing connections are made in the subinguinal wound. The perineal and subinguinal incisions are then closed.

Results
By adopting a streamlined approach and incorporating time-saving maneuvers as shown in the video, we have been able to perform AUS placements in thirty minutes or less. This includes patients who have undergone radiation therapy for prostate cancer. There were no complications.

Conclusions
This video demonstrates the key time-saving steps to facilitate AUS placement in 30 minutes or less.

Funding: none