For severe post-prostatectomy incontinence the artiUcial sphincters remains gold standard whenever some patients can be cured with slings or cushions. AMS800 has been the Eagship over nearby 50 years as a  system with a static pressure around the urethra. If the pressure is changing the system has to be exchanged. 12 years ago Zephyr 375 came on the marked with the possibility of adjustation, Victo followed with another techique but also adjustibility. There are som patients which have not so very huge urin losses over the day, but they are bothered by losses when coughing, laughing, sneezing, rising up from a seat and so on. Their problem is, that the intravesical pressure is infuenced by the intraabdominal pressure and sometimes they have a wave of overpressure which the cuff with 60 to 100 mBar cannot hold. Victo+ was the frst device with a second "press released balloon" but is - in Germany - not longer available. Since spring 2023 we have now RigiCon ContiReflex available in Germany which has a double balloon with a bypass to the cuff for these overpressure waves. Another problem are severe altered urethrae where we implant double-cuffs in an transcorporeal way.

6 patients where identifed to have overpressure incontinence follwingcradical prostatectomy with bladder volumes of 320 to 470 ml. They were dry at night and had daytime losses of 240 to 420 ml. All six had severe urethral problems in their history as reconstructed urethrae and arrosions of former implants. Surgery was performed in lithotomy position. The urethra was exposed by a perineal access. Then electrical vertical incisions were made in the tunica albuginea and a way through the cavernous bodies behind the
urethra was established. The cavernous bodies are closed by suture of
the lateral parts of the incision to prevent hematoma. After
measurement of the surrouding of urethra two cuffs were inserted, then
connected with the pump an the ContiReflex cuff by a high inguinal
incision.
Systems are deactivted by a button on the pump and a 12F Foley stays
for 2 days.
After 6 weeks the systems were activated.

All six patients are dry at daytime now and within pressure episoded.
We tested it with coughing and laughing during our consultation.
Patients are completely satisUed.
There are no longtime results of the behave of urethrae.

ContiReflex is another tool to cure postprostatectomy incontinence with
high pressure leakage.
The static artiUcial sphincters like AMS800 or Zephyr ZSI475 are the
standard for leakages between their pressure ranges.
But ContiReflex is the tool for the very short but very high pressures to
leak during coughing and other problems.
In this small study we showed that ContiReflex is also implantable with
two cuffs around the severe pretreated urethrae.
For a small part of all patients with post-prostatectomy incontinence it
is a very good chance to get dry.

For a small part of all patients with post-prostatectomy incontinence it
is a very good chance to get dry.