V11-05 Ams800 Artificial Urinary Sphincter: A Novel Modified Easier Technique

You have accessJournal of UrologyBPH/Male Voiding Dysfunction/Infection/Misc. Imaging (V11)1 May 2024V11-05 AMS800 ARTIFICIAL URINARY SPHINCTER: A NOVEL MODIFIED EASIER TECHNIQUE Ivano Morra, Luciano Ola, Ettore Dalmasso, Roberta Aimar, Francesca Ragni, Sabrina Titti De Cillis, and Cristian Fiori Ivano MorraIvano Morra , Luciano OlaLuciano Ola , Ettore DalmassoEttore Dalmasso , Roberta AimarRoberta Aimar , Francesca RagniFrancesca Ragni , Sabrina Titti De CillisSabrina Titti De Cillis , and Cristian FioriCristian Fiori View All Author Informationhttps://doi.org/10.1097/01.JU.0001009368.07681.43.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS), specifically the AMS 800TM (Boston Scientific) is considered the gold standard for the treatment of male stress urinary incontinence (SUI). AUS placement is an invasive procedure that can result in adverse events. AMS 800TM implantation can be done either with a transcrotal approach or with a two-incision approach (median perineal and abdominal). We describe a novel implantation technique of all the AUS components with the aim of making the procedure safer and faster. METHODS: We performed a retrospective, double-centre, single-arm study. All patients received an intravenous antibiotic prophylaxis (ceftriaxone and amikacine). All surgeries were performed in the lithotomy position and under spinal anaesthesia and a 2-minutes chlorhexidine scrub of lower abdomen, genitalia, and perineum was performed. We performed a first perineal median incision for cuff placement and a second minimal incision at the root of the scrotum for the placement of the other components. The external inguinal ring is identified and the floor of the inguinal canal is opened and penetrated using scissors or a fingertip in order to positioning the pressure regulating balloon (PRB) in the retropubic space. Through the same incision the control pump is positioned into the anterior scrotum. All components' connections are made at the level of scrotum incision to avoid blind passages. At the end of the surgery a 14 Ch Foley catheter was placed. Complication rate and efficacy were analyzed. RESULTS: 55 patients were treated with this technique between 2017 and 2022. The average age was 71.5 (± 5.1). All patients had previously undergone robot-assisted radical prostatectomy (RARP) and 10 (18%) of these also underwent adjuvant radiotherapy. 4 patients had previously undergone mid-urethral sling placement and 3 had proACT sphincter placement. Mean preoperative daily number of pads was 4.3 (± 2.1) and median preoperative pad test and IPSS score were 450 g (IQR 300-900) and 5 (IQR 4-5), respectively. The average operating time was 35 minutes and the average hospital stay was 2 days (IQR 2-4). Concerning minor and major intra and postoperative complications we didn't report any cases of infection, hematomas, urethral lesions, bleeding, bladder and intestinal perforations or need for surgical revision (for any reasons). We did not observe any cases of post-operative scrotal pain. At 12 months follow-up 94 % of patients were social continent. Median postoperative pad test and IPSS score were 15 (0-30) g and 2 (IQR 1-3). CONCLUSIONS: Our technique is safe, effective and well tolerated. This approach allows for easier component positioning, avoiding blind tunneling to create connections and reducing the risk of hematomas and scrotal pain. The main limitation of this approach is that it cannot be proposed in patients who have undergone bilateral inguinal hernioplasty. Source of Funding: Medical records © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e912 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ivano Morra More articles by this author Luciano Ola More articles by this author Ettore Dalmasso More articles by this author Roberta Aimar More articles by this author Francesca Ragni More articles by this author Sabrina Titti De Cillis More articles by this author Cristian Fiori More articles by this author Expand All Advertisement PDF downloadLoading ...