Novel tube positioning technique for AMS 800™ artificial urinary sphincter placement

Balzarro M1, Rubilotta E1, Sebben M1, Bassi S1, Cerruto M A1, Porcaro A B1, Pianon R1, Artibani W1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 98
Open Discussion ePosters
Scientific Open Discussion ePoster Session 7
Wednesday 29th August 2018
12:05 - 12:10 (ePoster Station 4)
Exhibition Hall
Biomechanics Incontinence Male Surgery Stress Urinary Incontinence
1. Dept. of Urology, AOUI Verona, Italy
Presenter
E

Emanuele Rubilotta

Links

Poster

Abstract

Hypothesis / aims of study
We describe a novel method of tube placement, in AMS-800 artificial urinary sphincter positioning, to avoid the risk of damage of the tubing system in case of suprapubic tube, or laparotomy is required.
Study design, materials and methods
We prospectively evaluated 34 consecutive male patients who underwent AMS-800 placing. In our modified tubing-positioning technique the lower limit of the dissection of abdominal fascia was the abdominal face of the pubic symphysis and the pectineal ligament. The lateral limit was the insertion of the aponeurosis at the external abdominal oblique muscle. The abdominal fascia was incised more laterally to position the balloon as far as possible from the midline. Before completing the connections, the tubing was fixed at the most lateral site of the aponeurosis with 3 stitches to stabilize tubing. Figure 1 illustrates the dissection area, ideal tubing allocation, and spots where to fix by sutures. Figure 2 shows tube placement documented by 3D CT scanning and abdominal X-ray.
Results
There was no mechanical failure caused by any malfunctioning component. No patient had complications attributed to the new tubing path.
Interpretation of results
The AMS-800™ positioning technique has been described in detail.1 However, the usual tubing path has been the shortest path from the tubing entry point in the retropubic abdominal area to the reservoir. As represented in Figure 3, this path ideally corresponds to the hypotenuse of a hypothetical right triangle, wherein it is the shorter and more medial path between the two acute angles (the tubing entry point and the reservoir). However, owing to its medial position, this route is potentially more dangerous in cases wherein ST placement is necessary. The tubing path described in this paper corresponds to the line of the two cathetus of the hypothetical right triangle. The shorter cathetus is in the retropubic space, covered and protected by the pubic bone. The longer cathetus is far from the possible zone of surgical incision or ST trocar passage because of its lateral position. For these reasons, this modified tubing positioning helps guarantee a lower risk of damaged tubing in case of ST placement or laparotomy. In our practice, we preferred to use non-absorbable material in the three sutures used to stabilize tubing in the curve points. However, it is conceivable that absorbable stitches might have similar results because of bonding of the dissected subcutaneous fat tissues. Sutures must not be tightened but air knots are suggested to ensure suspension without constricting the tubing.
Concluding message
Our novel tube positioning technique is quick, easy to perform, and offers the advantage of allocating tubing in a more safe position in the case a suprapubic tube is required.
Figure 1
Figure 2
References
  1. Sarez O.A., McCammon K.A.: The artificial urinary sphincter in the management of incontinence. Urology, 92: 14, 2016.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Internal Ethics Committee Department of Urology AOUI Verona Helsinki Yes Informed Consent Yes