Is the penoscrotal approach inferior to the perineal approach for artificial sphincter implantation in male urinary incontinence? A preliminary experience.

Artificial urinary sphincter is the gold standard of treatment for urinary incontinence as a result of sphincter incompetence. The perineal incision for cuff placement, and low abdominal incision for the placement of a pressure-regulating balloon and pump is the original design. Wilson et al. presented a modified method by a single penoscrotal (transscrotal) incision for implantation of all pieces. However, some experts believe there are important differences between the two methods, and the traditional perineal incision is better than the modified penoscrotal incision. The objective of our study was to show the characteristics of penoscrotal incision and determine whether the penoscrotal approach is inferior to the perineal approach in clinical outcome and complications. From May 1994 to July 2011, a total of 21 male patients underwent 27 artificial urinary sphincter implantations. Twelve cuffs were placed with the perineal approach and 15 with the penoscrotal approach. The patients in the penoscrotal group had a shorter operative time (86.0 ± 21.1 vs 115.4 ± 32.0 min, P = 0.018) and hospital stay (5.4 ± 2.2 vs 9.3 ± 2.5 days, P = 0.002) compared with the perineal group. There was no statistical significance in long-term completely dry rate (penoscrotal vs perineal: 66.7% vs 50%, P = 0.767), infection rate (20% vs 33.3%, P = 0.617) and subsequent tandem cuff-added rate (6.7% vs 16.7%, P = 0.675) between the two approaches. Hence, penoscrotal incision is not inferior to traditional perineal incision for artificial urinary sphincter implantation in male urinary incontinence.