V10-02 Immediate and Long-Term Outcomes of 3-Incision Artificial Urinary Sphincter Placement: Can a Third Incision Reduce Complications Related to the Pressure Regulating Balloon and Pump?

You have accessJournal of UrologyLower Tract Reconstruction (Including Transgender) I (V10)1 May 2024V10-02 IMMEDIATE AND LONG-TERM OUTCOMES OF 3-INCISION ARTIFICIAL URINARY SPHINCTER PLACEMENT: CAN A THIRD INCISION REDUCE COMPLICATIONS RELATED TO THE PRESSURE REGULATING BALLOON AND PUMP? Marissa Maas, Emily Markarian, David Ginsberg, Stuart Boyd, and Jeffrey Loh-Doyle Marissa MaasMarissa Maas , Emily MarkarianEmily Markarian , David GinsbergDavid Ginsberg , Stuart BoydStuart Boyd , and Jeffrey Loh-DoyleJeffrey Loh-Doyle View All Author Informationhttps://doi.org/10.1097/01.JU.0001009392.30237.90.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since 1984, our institution has relied on three incisions during Artificial Urinary Sphincter (AUS) placement. Using separate incisions to place the Pressure Regulating Balloon (PRB), control pump, and cuff, allows for precise and safe placement of the pump and PRB in the lateral retroperitoneum (LR), a space that we have utilized broadly during prosthetic reservoir placement. In this video, we describe technique and outcomes of using separate incisions to place all components of the AUS in a contemporary cohort of patients at a high-volume AUS center of excellence. METHODS: We performed a retrospective chart review of patients who received first-time AUS devices between March 2006 and November 2021. Intraoperative complications as well as any revision surgery undergone by these patients related to their pump and reservoir were collated. The urethra is accessed through a perineal incision. After the urethra is mobilized and measured, the LR space is accessed via a separate incision medial to the iliac crest. The aponeurosis of the external oblique muscle is identified, incised, and muscle fibers are split. Blunt dissection is then used to develop a space in the LR above the fascia to a subinguinal incision that is made to place the control pump. A combination of blunt and sharp dissection is used to create a space towards the midline of the scrotum to accommodate the pump. The pump is placed and connected to the PRB. The same incisions and method of dissection can be used to gain access to the reservoir and pump for removal or revision. RESULTS: A total of 541 patients were included, all of whom received placement of the PRB in the LR and the pump through a separate subinguinal incision. There were no intraoperative complications during initial PRB placement, subsequent explantations, or revisions. 9 patients developed a total of 10 reservoir-specific postoperative complications, including infection (5), reservoir hernia or palpability (3), and PRB leak (2). 6 patients required surgery to relocate a pump that had migrated and 3 experienced pump malfunction that required replacement. CONCLUSIONS: A "three-incision" AUS placement technique that includes PRB placement in the LR and pump placement through a subinguinal incision is associated with low intraoperative and postoperative complication rates as well as low rates of device mechanical failure. Separation of each component through separate incisions is reproducible, safe, and allows for precise placement and interrogation of all AUS components. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e826 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Marissa Maas More articles by this author Emily Markarian More articles by this author David Ginsberg More articles by this author Stuart Boyd More articles by this author Jeffrey Loh-Doyle More articles by this author Expand All Advertisement PDF downloadLoading ...