Ectopic placement of AMS 800 urinary control system pressure-regulating balloon

The AMS 800 sphincter urinary control system (artificial urinary sphincter) is frequently placed in patients with scarred retroperitoneal spaces. Placement of the pressure-regulating balloon (PRB) requires a second abdominal incision in the traditional perineal surgical technique. In the new transverse scrotal incision method of sphincter placement, the transversalis fascia is pierced to place the PRB in the space of Retzius. We present a novel technique of ectopic PRB placement requiring neither a second incision nor piercing the fascia.

Nineteen patients underwent ectopic PRB placement during artificial urinary sphincter placement. Most patients (n = 17) were incontinent after radical prostatectomy, two were incontinent after transurethral resection of the prostate. Cuff placement was through a scrotal (n = 10) or perineal (n = 9) incision. In all patients, the incision was displaced toward either inguinal ring. A finger was passed through the ring forcibly cephalad and a space developed anterior to the transversalis fascia but beneath the abdominal muscles. The PRB was passed into this space.

The results of our study have shown that ectopic placement is easier and quicker. The PRB is usually not palpable. Two PRB hernias into the upper scrotum were noted after vigorous coughing. Two patients developed urethral atrophy under the cuff at 3 and 5.5 years. No erosions, infections, or mechanical failures were noted. Early outcomes with ectopic PRB placement seemed similar to that of traditional locations.