In men with urinary incontinence due to spinal cord injruy, it is recommended to place the artificial urinary sphincter (AUS) cuff around the bladder neck to spare antegrade ejaculation, to avoid the risk of pressure ulcers at the perineal incision site and to limit the risk of cuff erosion due to clean-intermittent-self-catheterization (CISC). The objective of this study was to describe a surgical technique of bladder neck AUS implantation in neurogenic male patients.

The technique of bladder neck AUS implantation in men is described in this video. We present the case of a 43 year-old male with a past medical history of urinary incontinence due to spinal cord injury. The patient performed 5 to 6 CISC per day The maximum urethral closure pressure was 25 cm H2O and no detrusor overactivity evidence on urodynamics. Stress urinary incontinence persisted after  ACT periurethral ballons implantation.

The procedure is performed under general anesthesia. The patient is placed in a 23° Trendelenburg position. A robotic transperitoneal approach is performed and five ports are placed in total, including three ports for the robotic arms and one 12 mm-port for the assistant surgeon to allow the insertion of the AUS cuff.  First, the peritoneum is opened just above the seminal vesicles. The space between the posterior part of the prostate and the seminal vesicles is dissected. The bladder is then released down and the Retzius space is dissected. The lateral sides of the prostate are dissected and the endopelvic fascia is opened on both sides. A Prograsp forceps is used to open the angle between seminal vesicles and bladder on both sides from inside to outside. A measurement tape is then passed around the bladder neck and the AUS cuff is inserted through the 12-mm port. The balloon is implanted in the Retzius space through a 3 cm suprapubic incision and the pump is placed in the scrotum by a subcutaneous passage made from the suprapubic incision.

This video report the feasibility of robot-assisted bladder neck AUS implantation in male patient with spinal cord traumatism incontinence. The benefits of positionning the AUS cuff around the bladder neck (vs. bulbar urethra) and of the robot-assisted approach to perform this bladder neck implantation (vs. open or laparoscopic approaches) remain to be proven by clinical research studies.

Continence 2S2 (2022) 100489
DOI: 10.1016/j.cont.2022.100489