Complicated artificial urinary sphincter insertion using the transcorporal cuff: keys to the tunical flap technique

Al Saffar, H; Sandhu, K; O&#39;Brien, JS; Wang, QW; Kelly, BD; Moon, D

Author(s): Al Saffar, H; Sandhu, K; O'Brien, JS; Wang, QW; Kelly, BD; Moon, D;
Details: Publication Year 2024-04-30,Volume 13,Issue #4,Page 568-573
Journal Title: Translational Andrology and Urology
Publication Type: Research article
Abstract: Urethral sphincter insufficiency following radical prostatectomy (RP) is a common cause of non-neurogenic stress urinary incontinence (SUI). Artificial urinary sphincter (AUS) insertion remains the standard of care for fit patients with SUI refractory to non-operative interventions. The proximal urethra is a common location for uncomplicated AUS placement. However, previous failed AUS, urethroplasty, or pelvic radiotherapy (RT) may compromise urethral tissue requiring technique modifications that optimise outcomes. In these situations, transcorporal cuff (TC) placement has been well described to facilitate continence restoration in men where there is no other feasible option other than urinary diversion or permanent incontinence. In the traditional TC approach, the procedure may be complicated by haematoma due to difficulty in completely closing the corporal defects behind the urethra. This narrated video demonstrates the tunical flap (TF) modification for transcorporal AUS implantation via a perineal and penoscrotal approach in patients with prior failed AUS placements secondary to urethral erosion. The TF technique for transcorporal AUS insertion provides circumferential reinforcement with tunica albuginea from the corpora cavernosa. Here, we show how this technique provides additional urethral support for compromised urethral tissue to help prevent cuff erosion. The TF preserves the corporal volume and does not limit candidacy for future penile prosthesis implantation. In our early results, there have been no postoperative haematoma formation with this technique.
Publisher: AME Publishing Company
Keywords: Artificial urinary sphincter (AUS); perineal; transcorporal cuff (TC)
Department(s): Surgical Oncology
Publisher's Version: https://doi.org/10.21037/tau-23-641
Open Access at Publisher's Site: https://doi.org/10.21037/tau-23-641
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-07-30 06:26:11

Last Modified: 2024-07-30 06:34:07