Comparation between penoscrotal approach with perineal approach for artificial sphincter implantation in male urinary incontinence
Ping-Chia Chiang, Ho-Hsiang Chang, Mu-Yao Tsai, Yuan-Chi Shen, Po-Hui Chiang
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Artificial urinary sphincter is the solution for urinary incontinence that caused by sphincter malfunction and incompetence. The traditional approach was made with two wounds, including a perineal incision for cuff placement, and a low abdominal incision for pump and pressure-regulating balloon. A modified approach was introduced by Wilson et al., in which a single penoscrotal incision was made for the cuff, pump, and balloon. The debate between both techniques has existed for decades. Therefore, the aim of this study is to compare the characteristics and long-term outcomes of both approaches.
Materials and Methods:
We retrogradely reviewed medical charts of total 34 male patients (49 procedures) of artificial urinary sphincter implantation by a single surgeon from February 2015 to July 2020 in a single institute. They were divided into two groups: the penoscrotal group (24 patients, 35 procedures), and the perineal group (10 patients, 14 procedures) as comparison. All the implanted device was AMS800 and were carried out in standard steps. Those with incomplete data and lost follow-up were excluded. Median follow-up duration, age, etiology of incontinence, cuff size, hospital stay, and operation time were collected as parameter for analysis. The surgical outcomes were complete dry, infection, erosion, tandem cuff required, and revision.
The patients in the penoscrotal group had a shorter operation time (82.3 ± 29.0 vs 116.9 ± 35.9 min, p=0.007) and hospital stay (4 [3-6] vs 9 [7.0-10.5], p=0.003). The complete dry rate was 58.3% in perineal group and 42.9% in penoscrotal group, but no statistical significance existed between them (p=0.354). Among all the outcomes, there was no statistically significant difference in infection rate (perineal vs penoscrotal: 25.0% vs 34.3%, p=0.552), erosion rate (8.3% vs 14.3%, p=0.594), tandem cuff added rate (8.3% vs 2.9%, p=0.417), and revision rate (20.0% vs 37.1%, p=0.902).
The penoscrotal approach with single incision required shorter operation time and hospital stay. Concerning the similar long-term outcomes and complication rates of both techniques, the penoscrotal approach is a feasible choice of artificial sphincter implantation for urinary incontinence.