Artificial urinary sphincter advantage goes to perineal approach

The debate over the most appropriate surgical approach to placement of an artificial urinary sphincter (AUS) may be coming to a resolution. In the largest retrospective trial reported to date, Gerard Henry, MD, of Regional Urology in Shreveport, LA, found that the traditional perineal approach offers significantly better urinary control than the newer penoscrotal insertion.

"This is the first paper that looks at large numbers of patients," Dr. Henry said. "The results are very clear: when the AUS cuff is placed through a perineal approach, there is a higher completely dry rate and fewer requests for a second cuff than when the cuff is placed through a penoscrotal incision."

Dr. Henry was among the primary authors on the original 2003 report that sparked use of penoscrotal AUS insertion procedures. The traditional perineal approach is slower and more difficult, while the penoscrotal approach is faster and easier, he said.

Dr. Henry reviewed charts for 76 patients who underwent surgical correction for male urinary stress incontinence between January 1993 and May 2005. The men had 47 penoscrotal AUS placements and 49 perineal placements, usually for stress urinary incontinence secondary to treatment of prostate cancer.

Of the penoscrotal patients, 34% were completely dry after AUS placement compared with 51% in the perineal group.

The difference for second tandem cuff requests was even more dramatic. In the penoscrotal group, 8.5% requested a tandem cuff compared with 2% of the perineal patients.