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Transcorporal Artificial Urinary Sphincter Placement For Incontinence In High-risk Patients After Treatment Of Prostate Cancer

March 25, 2017

UroToday - Our single center observational cohort study sought to examine the indications for the usage of transcorporal placement of artificial urinary sphincter (AUS) for incontinence after treatment for prostate adenocarcinoma.

Our study shows that after 2 years of follow-up the transcorporal approach to AUS placement is an effective primary or salvage incontinence therapy. We further analyzed this cohort by also including observational data for men treated for incontinence with a standard cuff placement AUS. What we found was that despite the higher incidence of prior radiation, multiple urethral surgeries, or both, the transcorporal approach fared as well as the standard. The reason for this finding presumably is related to the extra corporal tissue backing the dorsal urethra beneath the inflatable cuff. The need for this supportive backing we propose is secondary to the relatively de-vascularized urethra from prior insult that predisposes it to cuff erosion and infection.

One drawback to placement of a cuff through the corporal bodies is resultant erectile dysfunction. In our series, most if not all men were impotent from prior therapies thereby precluding this as a true concern. We did have one patient who went on to also receive a 3-piece inflatable penile prosthesis with good results.

We do not presume that transcorporal cuff placement is superior to the standard approach in all cases, but in carefully selected high-risk patients with erectile dysfunction it may well be a better choice.

David S. Aaronson, MD, as part of Beyond the Abstract on UroToday

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