Innovation in Restoration - Boston ScientificInnovation in Restoration

Artificial urinary sphincter placement preserving the bulbospongiosus muscle

Argimiro Collado Serra, MD - Spain

Artificial urinary sphincter AMS-800® is an effective treatment for male stress urinary incontinence. Usually, the bulbospongiosus muscle is opened in the midline and the cuff is placed around the exposed bulbous urethra.

In our opinion, AUS placement preserving this muscle, it has several anatomical advantages. Firstly, could decrease the risk of urethral injury during the sharp dissection of its dorsal wall, often unnoticed. Sometimes, that is misinterpreted as early erosion (especially in patients with a history of previous surgery or radiotherapy (who are at greater risk). Secondly, according to figure (two black arrows), preserving the muscle allows to increase several millimeters the posterior wall on which the cuff is seated. Anatomical studies show that the posterior wall is the thinnest part of the circumference, therefore, gaining several millimeters at that level is very important. Finally, hypothetically, it could better preserve the blood flow to the urethra (less dissection of the bulbous urethra).

For readers critical with this technique, there is not a high risk of muscular atrophy as our data shows a lower urethral erosion rate and delays the onset of atrophy with not compromising continence results (https://www.ncbi.nlm.nih.gov/pubmed/27654121). 

Bibliography
Prospective follow-up study of artificial urinary sphincter placement preserving the bulbospongiosus muscle. Neurourol Urodyn. 2017 Jun;36(5):1387-1394. doi: 10.1002/nau.23119. Epub 2016 Sep 21. Collado Serra A, Domínguez-Escrig J, Gómez-Ferrer Á, Batista Miranda E, Rubio-Briones J, Solsona Narbón E).