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AUS Insertion by AMS-800™ URINARY CONTROL SYSTEM

Boston Scientific

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2019

The patient was given IV antibiotics, then taken to the operating room and placed under general anesthesia. He was placed in a lithotomy position. A 14 French Foley catheter was placed in the bladder. We made a midline perineal incision and carried this down through the subcutaneous tissues with a cautery. We divided the bulbospongiosus muscle in the midline and dissected back proximally. At the most proximal point of the bulbar urethra, we dissected circumferentially around the bulbar urethra, taking great care not to injure the spongiosum. We took a measurement, which appeared to be between a 4.0 and 4.5 cm; the 4.0cm cuff I think would have been a bit too tight and so we felt a 4.5 cm cuff was more appropriate for. We insufflated the urethra with an antibiotic solution under pressure and this revealed no extravasation. A 4.5 antibiotic impregnated cuff was prepped and snapped into position around the bulbar urethra with an excellent fit. We made a counterincision in the left lower quadrant and carried this down through the subcutaneous tissues with the cautery. We placed stay stiches of 2-0 Monocryl in the fascia and made a small fasciotomy. We developed the space below the fascia and below the muscle in the perivesical space and placed a prepped 61-70 pressure regulating balloon. We closed the fasciotomy with the stay stitches and then placed 24 cc of normal saline into the pressure regulating balloon. We tunneled the tubing of the cuff from the perineal incision up to the left lower quadrant incision. We made a space going from the left lower quadrant incision down the perineal incision. We placed a prepped antibiotic impregnated control pump into the left hemiscrotum in a subdartos location. We made connections at the level of the left lower quadrant incision using a straight connector to go from control pump to pressure regulating balloon and a right angel connector to go from control pump to cuff.

Procedure Steps:

Perineal Incision
Dissect down to bulbospongiosus
Dissect around urethra
Measure urethral diameter
Place cuff around urethra
Lower quadrant incision
Place pressure regulating balloon
Place pump into scrotum
Make connections
Colostomy creation.

Learning Points:

Careful dissection around urethra
Accurate measurement of cuff size
Proper cuff position
Proper pump position in scrotum

Clinical Case:

68-year-old man
Current problem: Bilateral renal colics
Prostate cancer

Other:

Patient with a prior radical prostatectomy (two years ago) with resulting persistent urinary incontinence