• Waleed Altaweel, Razan Almesned, and Raouf Seyam.
• From the Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
• Ann Saudi Med. 2023 Jan 1; 43 (1): 576157-61.

BackgroundThe two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes.ObjectiveCompare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach.DesignRetrospective study.SettingTertiary referral center.Patients And MethodsWe included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively.Main Outcome MeasuresRates of dry, infection, erosion, malfunction, atrophy, revision.Sample Size44 males who underwent 68 procedures.ResultsTwenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (P=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, P=.042). At the last follow-up, dryness was comparable among groups.ConclusionThe outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal.LimitationsSmall sample size, single-center.Conflict Of InterestNone.

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