Abstract
OBJECTIVES: To primarily compare efficacy and safety of transverse scrotal (TS) versus transperineal (TP) artificial urinary sphincter (AUS) implantation for post-prostatectomy urinary incontinence (PPUI). The AUS is the gold standard for managing severe refractory male SUI. PATIENTS AND METHODS: This single-centre, retrospective, cohort study, analyses 179 consecutive patients who underwent primary AUS implantation for PPUI between 2005 and 2018. Data on 24-h pad weight tests (PWT), validated quality of life questionnaires (I-QoL), surgical technique, related complications, salvage radiation and transcorporeal cuff placement (TC) were collected. RESULTS: The TP approach was performed in 43 cases, whilst 136 patients underwent TS incision, of which 31 benefited from TC placement. The median PWT reduction was 458 g (320, 701) in the TP and 479 g (258, 745) in the TS group (p = 0.807). The median I-QoL index increase was 40 (26, 52) in the TP and 48 (36, 60) in the TS group, showing a significant difference in favour of the TS group (p = 0.012). The overall postoperative infection rate was 3.9%, with a lower risk in the TS group (RR = 0.23, p = 0.049). Erosion occurred in 9.0% of patients, with a higher relative risk observed in the TS group (RR = 1.34, p = 0.636); however, we found that the TC patients (consisting of salvage radiation patients) in the TS group drove this higher risk. Mechanical failure and subsequent revision were lower in the TS cohort (RR = 0.43, p = 0.004) and (RR = 0.42, p = 0.002), respectively. CONCLUSION: TS and TP approaches resulted in similar improvements in continence but a greater increase in quality of life in the TS group. While post-operative erosion rates and device survival were comparable, the TP group had higher rates of infection and mechanical failure, which may be relevant for surgical decision-making.