Abstract: PD29-03
Sources of Funding: none

Introduction

_x000D_ 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._x000D_

Methods

_x000D_ 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)._x000D_

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.

Funding

none