V3-03: Single Perineal Incision: A Novel Technique for Artificial Urinary Sphincter Placement

Video

Introductions and Objectives
Quality of life outcomes related to the management of prostate cancer are significantly important for the patient and clinician. Artificial urinary sphincter (AUS) placement has been a mainstay in the management of post-prostatectomy stress urinary incontinence (SUI). Traditionally, the technique for bulbar urethral placement of the AUS device utilized two incisions: a perineal incision and an inguinal incision. In 2003, Wilson et al introduced a single incision technique through a transverse scrotal incision. However, studies have suggested that the transverse scrotal approach has inferior outcomes compared to perineal placement. We demonstrate the feasibility of a novel approach to AUS placement through a single perineal incision.

Methods
IRB approval and proper informed consent were obtained prior to the study and filming of the procedure. In 2014, cadaveric model was used to establish the feasibility of creating a dartos pouch from a perineal incision. This model demonstrated that the traditional sub-scarpal access to the sub-dartos space could be replicated from the perineal incision. From 6/24/14 and 8/18/14, five patients with documented severe SUI following radical prostatectomy were selected for AUS placement via a single perineal incision approach. Routine preoperative evaluation included 24-hour pad test, urodynamics, and office cystoscopy. Patients with previous inguinal hernia repair and those whose external inguinal rings were not accessible due to anatomic distance were not managed with this technique. The video demonstrates the method for creating the sub-dartos pouch from the perineal incision and access of the external ring for ectopic reservoir placement. Additional steps are taken to prevent migration of tubing into the perineum.

Results
We successfully performed the single perineal incision technique in five patients. The pump was in standard dependent position with the deactivation button directed laterally in all cases. There were no perioperative or postoperative complications and all were discharged home on postoperative day one. All patients have been activated, utilizing their devices without difficulty and are satisfied with the position of the pump.

Conclusions
This study demonstrates the feasibility of a single perineal incision for AUS placement in the properly selected patient. Utilization of a single perineal incision for AUS placement is safe and effective. Longer follow-up will be necessary to confirm no pump related mechanical problems specifically related to this technique.

Funding: AMS Unrestricted Education Grant