Single perineal incision for artificial urinary sphincter: analysis of technique, outcomes, and experience

Background To describe a large series of male patients who underwent a minimally invasive single perineal incision artificial urinary sphincter (AUS) placement in patients with stress urinary incontinence. Methods A retrospective cohort study was performed with data collected from men undergoing AUS placement by a single high-volume surgeon over a 12-year period (2005 to 2017). Demographic and outcomes data related to AUS placement were recorded from electronic medical records, which included subjective histories and questionnaires. Institutional ethics approval was received. Results A total of 145 AUS were placed over the study period. Of these, 84 were performed through a single perineal incision for both device and reservoir placement. Almost all (n=81, 96%) reported pre-operative incontinence of more than 3 pads per day. Postoperatively, 75% were satisfied with their continence, with 21 (25%) complaining of recurrent incontinence. A total of 5 (6%) patients developed a post-operative infection, 10 (12%) had device erosion and 11 (13%) had device malfunction, but only 3 (4%) had reservoir dysfunction. A total of 24 (29%) patients required revision of their device at median of 20 months (IQR, 6-32.5 months). Conclusions Single perineal incision is a feasible, safe, and potentially superior approach for AUS placement and warrants consideration as an accepted approach due to its more rapid surgical times, lower morbidity related to a single incision with minimal fascial defect, and favorable complication rates.