To describe our modified “minimal-touch” technique for primary artificial urinary sphincter (AUS) placement and evaluate early device outcomes compared with a historical cohort. 

The “no-touch” technique for inflatable penile prosthesis  placement, although the concept is well-established in other areas such as orthopedic surgery, neurosurgery, and plastic surgery. The no-touch approach is based on the presumption that prosthesis infections result from direct inoculation of the prosthesis with local bacteria present on the surrounding skin.  Also, several studies have revealed a high prevalence of bacteria or bacterial biofilm on clinically-uninfected AUS devices at the time of revision for mechanical malfunction or urethral atrophy.

To our knowledge there is a relatively paucity of data regarding operative techniques to minimize skin-device interaction during AUS placement.  Starting in 2014, we implemented a “minimal-touch” protocol for AUS placement wherein the perineal and abdominal skin exposure is limited to minimize the risk for device seeding with skin flora.  Herein, we sought to describe our “minimal-touch” approach for AUS placement through a standard perineal approach. Moreover, we evaluated device outcomes with the “minimal-touch” approach compared to a historical cohort of patients who underwent AUS placement through a standard approach with full skin exposure.

We identified patients who underwent primary AUS placement at our institution from 1983 to 2020. A “minimal-touch” technique was implemented in 2014 wherein an Ioban® dressing is placed over the exposed abdominal and perineal skin to the AUS components from touching the patient’s skin, along with copious antibiotic irrigation and glove changes. Statistical analysis was performed to identify the rate of postoperative device infection in patients who underwent minimal-touch versus those who underwent our traditional technique.

526/2601 total procedures (20%) were performed using our “minimal-touch” approach, including 271/1554 patients (17%) who underwent primary AUS placement over the study period. 2.3% of patients experienced device infection after AUS procedures. 

In the “minimal-touch” era, 3/526 patients (0.7%) experienced device infection, including 1/271 (0.4%) of those with primary AUS placement. In comparison, 46/2075 patients (2.7%) experienced device infection using the historical approach, with 29/1283 (2.3%) of primary AUS placements result in removal for infection.

While early results appear promising, longer-term follow with greater statistical power is needed to determine whether this approach will lower the infection risk.    Notably, 90% of device infections occurred within the first 6 months after primary placement. The difference in cumulative incidence of device infections at 12-months did not meet our threshold for statistical significance for either the total cohort of all AUS procedures (primary and revision) or the sub-group of only those patients undergoing primary AUS placement (Gray K-sample test; p=.13 and 0.21, respectively).

The “minimal-touch” approach for AUS placement represents an easy-to-implement modification with potential implications on device outcomes.