Penoscrotal One-Incision Implantation of the Rigicon ContiClassic Artificial Urinary Sphincter

B. Cetin

Introduction: The perineal two-incision approach remains the standard for artificial urinary sphincter (AUS) implantation. The penoscrotal one-incision technique offers a simpler and faster alternative, particularly for surgeons experienced in inflatable penile prosthesis implantation.

Aim: To demonstrate penoscrotal one-incision AUS implantation facilitated by a self-retaining retractor.

Methods: A 70-year-old man presented with stress urinary incontinence (4–5 pads/day) six years after laparoscopic extraperitoneal radical prostatectomy for Gleason 4+3 prostate adenocarcinoma, followed by salvage radiotherapy to the prostatic fossa for biochemical recurrence three years ago. Current PSA was 0.09 ng/mL, and preoperative urethrography showed no stricture. A Rigicon ContiClassic® AUS was implanted under the proctorship of Prof. John J. Mulcahy and Prof. Steven K. Wilson. Low lithotomy positioning prevented urethral stretching. The Rigicon disposable self-retaining retractor with a penile strap elevated the penis, minimized bleeding, and provided stable exposure. Through a transverse penoscrotal incision, the tunica albuginea was cleared down to the crural decussation, the bulbospongiosus muscle was opened, and the proximal bulbar urethra was circumferentially mobilized. A 4.25 cm cuff was placed. The pressure-regulating balloon was placed retroperitoneally with closure of the external ring, and the pump was secured in a subdartos pouch with a purse-string suture.

Results: Operative time was 50 minutes, with minimal blood loss and no intraoperative complications; the urethra remained intact throughout circumferential mobilization. The urethral catheter was removed on postoperative day 1, and the patient voided spontaneously without urinary retention. No early postoperative complications, such as scrotal hematoma, wound problems, or infection, were observed. Device activation is planned at 6 weeks postoperatively

Conclusion: Self-retaining retractor exposure enables safe access to the proximal bulbar urethra and a short operative time through a single penoscrotal incision, even in an irradiated patient. This technique is a practical alternative to the perineal approach.

None.

None.