Transcorporal Artificial Urinary Sphincter Cuff Placement in a Case Requiring Revision for Urethral Atrophy

Summary

Here we describe the application of transcorporal artificial urethral sphincter (AUS) placement in a case requiring revision of an artificial urinary sphincter for urethral atrophy.

Abstract

Artificial urethral sphincter (AUS) implantation is the definitive management of male stress urinary incontinence (SUI). Under the long-term pressure of the cuff, recurrence of incontinence caused by urethral atrophy can always be observed in patients. In this situation, distal cuff locations are needed, and new cuff sites should be sought in patients who need to undergo AUS reimplantations. Meanwhile, the circumference of the more distal urethra is often too small to fit with a 4.0 cm cuff. This means that the bulk of the urethra should be added not only for a sufficient urethral circumference but also for better protection. Here, we report a case that required AUS reimplantation because of urethral atrophy. This 73-year-old man had undergone AUS implantation 7 years ago and developed incontinence in the past 3 months. Physical examination and ultrasonography determined that the device still worked, and no obstruction or injury was observed through cystoscopy. Surgery for revision of the AUS was needed. In this operation, a new cuff was implanted transcorporally, which was 2 to 3 cm distal to the original cuff site. During a 6 month short-term follow-up, no stress incontinence, urethral injury, or dysuria was observed. The transcorporal technique offers significant advantages in patients with urethral atrophy: corporal tunica albuginea is added to the urethra, allowing a suitable cuff size and lower risk of erosion. It is worth recommending in the reoperation of AUS implantation.

Introduction

In the past three decades, artificial urethral sphincter (AUS) implantation has been the definitive management for male stress urinary incontinence, and most patients can benefit from this technique¹. However, some patients may develop recurrences of slight incontinence with time, which is usually caused by urethral atrophy beneath the cuff. Meanwhile, patients who undergo urethral surgeries or radical prostatectomy may also develop stress urinary incontinence accompanying urethral atrophy. In these situations, the original cuff sites are not suitable for simply reimplanting a downsizing cuff, and a new cuff site or a second tandem cuff implant....

Protocol

The study was approved by the local Medical Ethics Committee of Shanghai Ninth People's Hospital in China. All of the studies were conducted in accordance with the World Medical Association Declaration of Helsinki. Written consent was obtained from the patient.

1. Preparations

1. Monitor the patient for the development of urethral injury or stricture under the long-term pressure of the original cuff through a flexible cystoscopy.
2. Ensure that the device w.......

Discussion

Artificial urinary sphincter implantation is the gold standard for the treatment of SUI, and high success and satisfactory rates have been reported⁷. Yafi and colleagues reported a 79% success rate and a90% satisfaction rate in their systematic review⁸. In the long-term follow-up, complications such as nonfunctioning devices, subcuff atrophy, erosion, and infection were reported to be common. For patients who develop subcuff atrophy or erosion, removing the original cuff an.......

Materials

Name	Company	Catalog Number	Comments
3-0 absorbable polyglatin suture	ETHICON	VCP311H	suture
5-0 absorbable polyglatin suture	ETHICON	VC433H	suture
Artificial urinary sphincter	Boston Scientific	AUS800	A device for managetment of male stress urinary incontinence
Cefuroxime sodium	Youcare Parmaceutical Group	H20063758	Antibiotics
Flexible cystoscopy	KARL STORZ	C-VIEW®	cystoscopy
Foley catheter	HAIYAN KANGYUAN MEDICAL INSTRUMENT CO., LTD.	20192140294	Catheter
Ornidazole	Pudepharma	H20040104	Antibiotics
Vancomycin	Eli Lilly Japan K.K,Seishin Laboratories	JX20130179	Antibiotics