Editing Functional: Surgery for Male SUI (section)

====== Technique ======

*'''<span style="color:#ff0000">Cuff is most commonly placed around bulbar urethra via a perineal incision.</span> The aim is to place the cuff as proximal on the bulbar urethra as possible, proximal to the convergence of the corporeal bodies'''
**'''Single cuff perineal approach is preferred, superior outcomes compared to transverse scrotal incision[https://pubmed.ncbi.nlm.nih.gov/31059663/ ★]'''
* '''Summary of Steps'''
** After incision of the skin, Colles fascia, and bulbospongiosus muscle, the Buck fascia is incised as it reflects off the bulbar urethra onto the diverging corporeal bodies.
** Create a 2-cm wide tunnel under direct vision using sharp dissection, dorsal to the Buck fascia over the roof of the urethra.
** Pass a right-angle clamp through this tunnel.
** Measure the circumference of the urethra around the corpus spongiosum to guide selection of cuff size, '''most commonly 4 or 4.5 cm.'''
** Pass the tubing from the AUS cuff through the overlying bulbospongiosus muscle into the deep perineal space beneath the Colles fascia.
** '''Place the pressure-regulating balloon'''
***'''May be achieved through a scrotal, perineal, or abdominal incision, depending on prior surgical incisions, body habitus, and surgeon preference.'''
**** '''<span style="color:#ff0000">Contraindications to the scrotal/perineal approach:</span>'''
****# '''<span style="color:#ff0000">Mesh hernia repairs</span>'''
****# '''<span style="color:#ff0000">Radical cystectomy and other extensive abdominal surgery</span>'''
***** '''<span style="color:#ff0000">In such cases, the abdominal approach reduces the risk for bladder or intestinal injury</span>'''
** '''Place the pump assembly into the anterior scrotum''' '''from the inguinal, scrotal, or perineal incision.'''
** After completing the connections, the device is cycled several times through the activation and deactivation states.
** '''Verify adequate coaptation of the urethra via urethroscopy.''' 
***'''The closed cuff should cause slight blanching of the urethral tissue''', indicating adequate urethral coaptation, filling, and connection of the device.
* '''Bladder neck AUS'''
** '''Remains an optional, although more invasive, method of cuff placement in men with sphincteric UI in whom the prostate is without external surgical or traumatic disruption.'''
*** '''Thus, for cases of myelomeningocele and other neuropathic disorders, it should be considered as an alternative to bulbar AUS.'''
*** '''Contraindicated after radical prostatectomy'''
** '''Advantages include lower likelihood of erosion and cuff atrophy'''
** '''Requires higher PRB pressures to ensure coaptation'''
* '''Postoperative deactivation of the cuff for 4-6 weeks is essential for proper healing without erosion.'''