Artificial Urinary Sphincter Placement for Male with Urinary Incontinence Following Radical Prostatectomy
Stephen Sekoulopoulos, MD; Joseph Y. Clark, MD
Penn State Health Milton S. Hershey Medical Center

Stress urinary incontinence (SUI) is a common condition in men due to decreased bladder outlet resistance. The most common cause of SUI in men is radical prostatectomy (RP), largely due to iatrogenic injury to the innervation of the internal and external urinary sphincters. While many patients elect for conservative management, those experiencing a significant detriment to their quality of life will elect to undergo some kind of intervention. The artificial urinary sphincter (AUS) is considered the gold standard treatment for men with mild-to-severe SUI. The AUS is a three-piece device, consisting of (1) the urethral cuff, (2) the control pump, and (3) the pressure regulating balloon. While multiple techniques have been described, a perineal incision is the most common approach. Dissection is carried down to bulbospongiosus muscle, which is divided and reflected off the proximal bulbar urethra to allow for cuff sizing. A second, lower abdominal incision is made to allow for placement of the pressure regulating balloon in the subrectus space along with creation of a subdartos scrotal pouch for placement of the pump. In this video, we present a case of a patient with moderate SUI following RP that was treated with placement of an AUS.