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Comparison Of Perineal And Penoscrotal Approaches For Artificial Urinary Sphincter Placement; Anatomic And Manometric Correlates
Jennifer Miles-Thomas, David J Hernandez, E. James Wright
Johns Hopkins University, Baltimore, MD
Introduction:
The efficacy of penoscrotal and perineal approaches for artificial urinary sphincter placement may not be equivalent. The purpose of this pilot study was to assess anatomic and manometric differences between these approaches in a cadaver model using direct urethral measurement and retrograde leak point pressure profilometry.
Methods:
Artificial urinary sphincter implantation using both perineal and penoscrotal incisions was performed in 10 fresh male cadavers. The surgical goal was to place the cuff as proximal as possible using each approach. A separate 4.5 cm cuff of the AMS 800 Sphincter Urinary Control System was placed in each location and a 61-70cm H20 pressure reservoir was used. Retrograde leak point pressure was assessed sequentially across each of these cuffs.
Results:
The mean urethral circumference using the perineal surgical approach and penoscrotal approach was 5.8 cm (range 4.5-7.5 cm) and 4.1 cm (range 3.5-4.5 cm) respectively (p=0.0008). The mean retrograde leak point pressures of the perineal and penoscrotal approaches were 91.26 cm H20 (range 88.5-94.5 cm H2O) and 66.44 cm H2O (range 57-90 cm H2O) respectively. The mean difference between the retrograde leak point pressure of the urethral cuff using the penoscrotal and perineal approaches was 24.825 cm H2O (27.2%, p=0.000014). Conclusions:
Although artificial urinary sphincter cuff implantation through a penoscrotal incision may be less technically demanding and conserve operative time, anatomic and manometric differences exist along the urethra which may limit efficacy. This pilot study demonstrates the need for further research evaluating urethral cuff placement techniques to provide optimal surgical outcomes.
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