Urology Video Journal (Jun 2023)
Artificial urinary sphincter insertion after male sling
Abstract
Objective: The artificial urinary sphincter is considered the gold standard for treatment of male stress urinary incontinence (SUI). The male sling is also an option with reasonable utility; however, in some cases the sling may lose efficacy over time. In this video, we demonstrate insertion of an artificial urinary sphincter in a patient who has persistent stress urinary incontinence despite having previously undergone insertion of a male sling twice for male stress urinary incontinence. Patient and surgical procedure: The patient is a 64-year-old male with history of radical retropubic prostatectomy for prostate cancer that resulted in SUI. He underwent male sling twice, but his incontinence persisted.A perineal incision was made, and the mid-bulbar urethra was circumferentially mobilized off its attachments to the tunica albuginea. The previously placed slings were not encountered. One the dorsal plane was sufficiently dissected, the urethral circumference was measured and cuff selected. A transverse lower abdominal incision was used to reach the Space of Retzius to accommodate the pressure regulating balloon, and to make a subdartos pouch in the scrotum for insertion of the control pump. The device components were prepped and inserted and connected. The device was cycled and deactivated prior to closure. Results: This patient had an uneventful recovery and achieved significant improvement in his continence once the AUS was activated. The artificial urinary sphincter can be inserted after a failed sling, with expectation of reasonable efficacy and without significant concern for added complexity from previous surgeries Conclusion: The artificial urinary sphincter is a safe and reliable option for stress incontinence that persists after insertion of male sling.
