Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures

Clémence Bernard; Imad Bentellis; Mehdi El-Akri; Matthieu Durand; Olivier Guérin; Jean-Nicolas Cornu; Tiffany Cousin; Victor Gaillard; Hugo Dupuis; Thibault Tricard; Nicolas Hermieu; Pierre Lecoanet; Franck Bruyère; Grégoire Capon; Xavier Biardeau; Elias Karam; Christian Saussine; Jean-François Hermieu; Benoit Peyronnet; Xavier Game; Thibaut Brierre

doi:10.1016/j.fjurol.2024.102604

Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures

Fr J Urol. 2024 Mar 11;34(3):102604. doi: 10.1016/j.fjurol.2024.102604. Online ahead of print.

Authors

Clémence Bernard¹, Imad Bentellis², Mehdi El-Akri³, Matthieu Durand², Olivier Guérin², Jean-Nicolas Cornu⁴, Tiffany Cousin⁵, Victor Gaillard⁶, Hugo Dupuis⁴, Thibault Tricard⁷, Nicolas Hermieu⁷, Pierre Lecoanet⁸, Franck Bruyère⁹, Grégoire Capon⁵, Xavier Biardeau¹⁰, Elias Karam¹¹, Christian Saussine⁶, Jean-François Hermieu⁷, Benoit Peyronnet³, Xavier Game¹², Thibaut Brierre¹²

Affiliations

¹ Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France. Electronic address: clemencebernarduro@gmail.com.
² Urology Department, Nice University Hospital, Nice, France.
³ Urology Department, Rennes University Hospital, Rennes, France.
⁴ Urology Department, CHU de Rouen, Rouen, France.
⁵ Urology Department, Bordeaux University Hospital, Bordeaux, France.
⁶ Urology Department, CHU de Strasbourg, Strasbourg, France.
⁷ Urology Department, Bichat Hospital, Paris, France.
⁸ Urology Department, Nancy University Hospital, Nancy, France.
⁹ Urology Department, CHU de Tours, Tours, France.
¹⁰ Urology Department, Lille University Hospital, Lille, France.
¹¹ Visceral Surgery and Liver Transplant Unit, CHU de Tours, Tours, France.
¹² Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France.

PMID: 38417628
DOI: 10.1016/j.fjurol.2024.102604

Abstract

Introduction: Artificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation.

Material and methods: Data from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS).

Results: Median follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as "dry" in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively.

Conclusion: The penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings.

Keywords: Artificial urinary sphincter; Functional results; Penoscrotal approach; Perineal approach; Reoperation-free survival; Résultats fonctionnels; Sphincter urinaire artificiel; Survie sans reprise chirurgicale; Voie pénoscrotale; Voie périnéale.