Mid-Term Follow-Up of the Zephyr 375 Artificial Urinary Sphincter Implanted via a Single Perineal Incision

The treatment for severe male stress urinary incontinence (SUI) following surgery refers to the implantation of an artificial urinary sphincter (AUS). Traditionally, the procedure requires two incisions: Perineal and inguinal.

To present a series of patients treated with the Zephyr 375 AUS implanted via a single perineal incision.

We report 14 male patients with SUI following transurethral resection of the prostate (1) and radical prostatectomy (13). Preoperative assessment included a pad test and cystoscopy. Under epidural anaesthesia, bulbar urethra was exposed through a vertical perineal incision via dissection and division of the bulbospongiosus muscle. After catheter removal, the cuff was placed around the urethra and tested to ensure appropriate pressure and then deactivated. The pump-reservoir was positioned by digitally creating a scrotal dartos pouch from the perineum and secured with a 3/0 Vicryl. The perineum was closed, and a urinary catheter was installed.

The mean age was 65 years (55-74), and the average operative time was 64 minutes (50-85). All patients were discharged the following day without a catheter. Each one of them can palpate the pump-reservoir in the scrotum. After activation, all patients achieved continence, with five requiring a safety pad. During follow-up, four patients required pressure adjustment due to diminished continence with desirable outcomes. Patient satisfaction was notably high.

After a mean follow-up of 19 months, the Zephyr 375 AUS demonstrated good functional outcomes for the treatment of severe male SUI. The system allowed for effective pressure adjustments when efficacy diminished. Implantation via a single perineal approach simplifies the procedure and reduces morbidity associated with dual-incision techniques.