Management of Inadvertent Urethral Laceration During Artificial Urinary Sphincter Implantation

B. Cetin

Introduction: Intraoperative urethral injury during perineal artificial urinary sphincter (AUS) implantation is rare and usually leads to abandonment of the procedure. To our knowledge, same-session salvage has not previously been demonstrated in a surgical video.

Aim: To demonstrate primary repair of an inadvertent urethral laceration and completion of AUS implantation in the same procedure.

Methods: A 75-year-old man presented with stress urinary incontinence (5–6 pads/day) 18 months after open radical prostatectomy for Gleason 3+4 prostate adenocarcinoma, with undetectable PSA. A Rigicon ContiClassic® AUS was implanted using the classic two-incision technique under the proctorship of Prof. John J. Mulcahy and Prof. Steven K. Wilson. The urethra was entered during perineal dissection because the catheter was not being palpated. Based on Prof. Mulcahy's experience with two similar cases, the laceration was meticulously closed in two layers. The incision was extended, and a healthy distal urethral segment was circumferentially mobilized off the tunica albuginea while the assistant palpated the catheter. The urethral circumference measured 3.75 cm, and a 4.25 cm cuff was placed. The pressure-regulating balloon was placed in the space of Retzius, and the pump was secured in a subdartos pouch.

Results: Retrograde urethrography at one week showed no extravasation, and the catheter was removed. Device activation was planned at six weeks.

Conclusion: In selected cases an inadvertent urethral laceration can be managed with meticulous two-layer repair and distal cuff placement without abandoning implantation. Continuous catheter palpation during urethral dissection is key to prevention.

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