Van Renterghem, K

Artificial urinary sphincters, penoscrotal incision, stress urinary incontinence

In this video we operate on a 67 year old male patient with severe stress urinary incontinence. Eighteen months ago he underwent a TURP whereafter he developed a therapy resistant stress urinary incontinence not responding to pelvic floor training for several months.He needed more than 4 pads a day that were heavily moisted. Preoperatively cystoscopy revealed no infra vesical obstruction and urodynamics showed a stable bladder with a normal capacity of over 300 cc.

The surgery is done through a single penoscrotal incision. We start with dissecting the urethra which is supported by using an atraumatic babcock clamp.This babcock clamp allows full control on the urethra and makes it possible to have a very proximal dissection of the urethra by pulling the babcock distally. By doing this, it is possible to get at the bulbocavernous muscle at the site of the bulbar urethra, which is exactly the same location as in the perineal approach. With well positioned rakes at the lower part of the scrotum we are able to reach the bulbar urethra. Measurement of the cuff is done as usual by using the tape-measure. While doing all this, the table nurse prepared the reservoir already, this reservoir is inserted in the left submuscular area, therefore we use an incision in the fascia of the external oblique muscle medial to the external inguinal ring. This incision is then closed by a preplaced “W” suture vicryl 1. The pump is placed in the midscrotum, tubings are connected and the wound is closed.

This video has been financially supported by Rigicon Company.

Consultant for Rigicon; Boston Scientific and Coloplast.

Jamaer C, De Bruyn H, van Renterghem A, Baten E, van Renterghem K. Penoscrotal Incision for the Primary Implantation of an Artificial Urinary Sphincter. Curr Urol. 2020 Jun;14(2):74-78.

Mykoniatis I, Osmonov D, van Renterghem K. A Modified Surgical Technique for Reservoir Placement During Inflatable Penile Prosthesis Implantation. Sex Med. 2020 Sep;8(3):378-382