Performance and safety of transverse scrotal vs transperineal AUS for PPUI: A retrospective cohort study

To primarily compare efficacy and safety of transverse scrotal (TS) versus transperineal (TP) artificial urinary sphincter (AUS) implantation for post-prostatectomy urinary incontinence (PPUI). The AUS is the gold standard for managing severe refractory male SUI.

This single-centre, retrospective, cohort study, analyses 179 consecutive patients who underwent primary AUS implantation for PPUI between 2005 and 2018. Data on 24-h pad weight tests (PWT), validated quality of life questionnaires (I-QoL), surgical technique, related complications, salvage radiation and transcorporeal cuff placement (TC) were collected.

The TP approach was performed in 43 cases, whilst 136 patients underwent TS incision, of which 31 benefited from TC placement. The median PWT reduction was 458 g (320, 701) in the TP and 479 g (258, 745) in the TS group (p = 0.807). The median I-QoL index increase was 40 (26, 52) in the TP and 48 (36, 60) in the TS group, showing a significant difference in favour of the TS group (p = 0.012). The overall postoperative infection rate was 3.9%, with a lower risk in the TS group (RR = 0.23, p = 0.049). Erosion occurred in 9.0% of patients, with a higher relative risk observed in the TS group (RR = 1.34, p = 0.636); however, we found that the TC patients (consisting of salvage radiation patients) in the TS group drove this higher risk. Mechanical failure and subsequent revision were lower in the TS cohort (RR = 0.43, p = 0.004) and (RR = 0.42, p = 0.002), respectively.

TS and TP approaches resulted in similar improvements in continence but a greater increase in quality of life in the TS group. While post-operative erosion rates and device survival were comparable, the TP group had higher rates of infection and mechanical failure, which may be relevant for surgical decision-making.