Single perineal incision for artificial urinary sphincter: analysis of technique, outcomes, and experience

To describe a large series of male patients who underwent a minimally invasive single perineal incision artificial urinary sphincter (AUS) placement in patients with stress urinary incontinence.

A retrospective cohort study was performed with data collected from men undergoing AUS placement by a single high-volume surgeon over a 12-year period (2005 to 2017). Demographic and outcomes data related to AUS placement were recorded from electronic medical records, which included subjective histories and questionnaires. Institutional ethics approval was received.

A total of 145 AUS were placed over the study period. Of these, 84 were performed through a single perineal incision for both device and reservoir placement. Almost all (n=81, 96%) reported pre-operative incontinence of more than 3 pads per day. Postoperatively, 75% were satisfied with their continence, with 21 (25%) complaining of recurrent incontinence. A total of 5 (6%) patients developed a post-operative infection, 10 (12%) had device erosion and 11 (13%) had device malfunction, but only 3 (4%) had reservoir dysfunction. A total of 24 (29%) patients required revision of their device at median of 20 months (IQR, 6-32.5 months).

Single perineal incision is a feasible, safe, and potentially superior approach for AUS placement and warrants consideration as an accepted approach due to its more rapid surgical times, lower morbidity related to a single incision with minimal fascial defect, and favorable complication rates.