New enhancements of the scrotal one-incision technique for placement of artificial urinary sphincter allow proximal cuff placement.
BACKGROUND
Urinary incontinence impairs sexual functioning and sexual satisfaction. Traditional artificial urinary sphincter (AUS) implantation requires perineal incision for cuff placement and a second inguinal incision for reservoir and pump placement. We believed AUS could be placed easier and quicker through one scrotal incision. Aim.  In an effort to effect more proximal placement of the cuff while keeping the advantages of the one scrotal incision technique, we report enhancements to the original surgical technique.


METHODS
Thirty patients have been operated upon using the enhanced technique. A modification of the SKW retractor system (AMS) facilitates deep bulbar exposure. Twenty patients were first time implantations and 10 were revisions with five of the revisions having had the original AUS placed by traditional two-incision technique. Two of the first time AUS patients received an inflatable penile prosthesis through the same incision.


METHODS
We evaluated site of cuff placement, sizes of cuffs used, postoperative continence status.


RESULTS
All of the virgin AUS required dissection of the bulbocavernosus muscle prior to cuff placement. In scrotally placed revisions, replacement cuffs were situated considerably proximal (4.5-7.5 cm) to the original cuff site. The perineal placed revisions were accomplished through a scrotal incision with replacement of two cuffs in the same site and the three other patients immediately distal. No intraoperative complications were seen. One patient developed scrotal hematoma requiring drainage. Only 15 patients are available for follow-up and all are socially continent (one pad or less).


CONCLUSIONS
Transscrotal approach is used safely and efficiently for penile implants and AUS implantation. The new enhancements to the one-scrotal incision technique allow more proximal cuff placement as evidenced by the bulbocavernosus muscle dissection and use of larger cuffs. Continence rate is similar to rates achieved with perineal placement of cuff found in the literature.
Wilson
Steven K
SK
Institutes of Urologic Excellence, Indio, CA, USA.
Aliotta
Philip J
PJ
Salem
Emad A
EA
Mulcahy
John J
JJ
D007172:Erectile Dysfunction / Q000517:prevention & control; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D012611:Scrotum / Q000601:surgery*; D016741:Urinary Sphincter, Artificial