title: [Dysfunctions of artificial urinary sphincters (AMS 800) and their management via a transscrotal access. Optimum procedure illustrated by reference to clinical examples].
abstract: BACKGROUND
  The introduction of a transscrotal access for implantation of an artificial urinary sphincter (AUS) offers an alternative to the perineal approach for dealing with post-prostatectomy incontinence. Should a revision be necessary, the entire implant can be explored via this access and only one incision is needed. The aim of our study was to present the advantage of the transscrotal approach in different malfunctions of AUSs (AMS 800).
  
  
  METHODS
  Surgical exploration was exemplary indicated in three male patients because of recurrent incontinence after artificial sphincter implantation. The reasons for malfunction were urethral atrophy, a mechanical defect of the device, and urethral erosion of the cuff, which led to explantation via the perineal approach of the entire artificial sphincter system. The patient whose sphincter system had a mechanical defect had the entire system substituted by the transscrotal route. In the case of perineal explantation a complete new AMS 800 system was implanted transscrotally at the unaffected bulbar ureter following complete healing. In the case of urethral atrophy a tandem-cuff was implanted by a transscrotal approach. Because of mechanical complications the whole system was exchanged, a completely new AUS (AMS 800) system being implanted by the transscrotal approach after perineal explantation.
  
  
  RESULTS
  There were no complications of any of the revision operations. The postoperative course was uneventful and after activation of the system all patients regained their former continence status. Three months after implantation all patients remained continent and their AMS 800 sphincter systems were fully functional.
  
  
  CONCLUSIONS
  When a revision operation is needed, the transscrotal access offers a quick and easy alternative to the perineal method. Our patients had no postoperative complications, and their continence rates were satisfactory. Further studies are needed to reveal whether this approach will prove superior to the perineal approach in the long term.
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, Kiel, Germany. cvanderhorst@urology.uni-kiel.de
authors.forename: C
authors.initials: C
authors.lastname: van der Horst
authors.forename: C M
authors.initials: CM
authors.lastname: Naumann
authors.forename: S K
authors.initials: SK
authors.lastname: Wilson
authors.forename: B
authors.initials: B
authors.lastname: Wefer
authors.forename: P M
authors.initials: PM
authors.lastname: Braun
authors.forename: K P
authors.initials: KP
authors.lastname: Jünemann
mesh_terms: D000368:Aged; D001284:Atrophy; D020878:Device Removal; D006801:Humans; D008297:Male; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012611:Scrotum / Q000601:surgery; D014521:Urethra / Q000473:pathology / Q000601:surgery; D014549:Urinary Incontinence / Q000601:surgery*; D016741:Urinary Sphincter, Artificial