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Laparoscopic implantation of an artificial urinary sphincter around the prostatic urethra.

Chłosta P, Aboumarzouk O, Bondad J, Szopiński T, Korzelik I, Borówka A - Arab J Urol (2015)

Bottom Line: There were no complications.After activating the AUS the patient was totally continent.The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Jagiellonian University, Cracow, Poland ; Department of Urology Medical Centre of Postgraduate Education, Warsaw, Poland ; Department of Urology, Institute of Oncology, Kielce, Poland.

ABSTRACT

Objective: To report the first laparoscopic periprostatic implantation of an artificial urinary sphincter (AUS) after a transurethral resection of the prostate.

Background: The implantation of an AUS is a standard procedure for severe urinary incontinence. In men it is usually implanted through a perineal approach, with the cuff placed around the bulbous urethra, bladder neck, or even around the prostate.

Method: We report a laparoscopic periprostatic implantation of an AUS after a transurethral resection of a prostate in a 72-year-old-man with incontinence.

Results: The operative duration was 180 min and the blood loss was 150 mL. There were no complications. After activating the AUS the patient was totally continent.

Conclusion: The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure.

No MeSH data available.


Related in: MedlinePlus

Start of the dissection of the rectovesical pouch.
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f0010: Start of the dissection of the rectovesical pouch.

Mentions: The patient was operated under general anaesthesia and placed in the Trendelenburg position. The trocar placements were similar to those for a laparoscopic radical prostatectomy. A 10-mm trocar was placed at the level of the umbilicus. Two 10-mm working trocars were inserted lateral to the rectus and just inferior to the umbilical trocar bilaterally. Two further 5-mm trocars were placed at the mid-clavicular line and medial to the anterior superior iliac spine bilaterally. The five-trocar configuration created a fan-shaped array (Fig. 1). Dissection was carried out from the superior part of the rectovesical pouch, then to the fascia posterior to the seminal vesicle, and down to Denonvilliers’ fascia (Fig. 2). After this, the endopelvic fascia was dissected bilaterally to gain access to the retropubic space. As a result, a ‘tunnel’ between the prostate and rectum is created in which a cuff with a specific length can be introduced (Fig. 3). The 0° laparoscope was used for most of the procedure, but a 30° laparoscope was necessary for the dissection of the prostate, for the measuring tape and the cuff. The diameter of the AUS that was required was measured using the measuring tape introduced via the right-sided 10-mm working port. The AUS (AMS 800) was subsequently implanted around the prostate (Fig. 4). A 5-cm lower midline incision was made to accommodate the insertion of the reservoir. All remaining parts of the AUS were placed and connected in a standard manner. The total duration of the procedure was 180 min and the estimated blood loss was 150 mL. There were no complications during or after the surgery. At 48 h after the procedure, the urinary catheter was removed and the patient was discharged from the hospital. The AUS was activated 1 month after surgery. After 1 year the patient maintained continence, with no accidental leakage reported and no malfunction problems with the device.


Laparoscopic implantation of an artificial urinary sphincter around the prostatic urethra.

Chłosta P, Aboumarzouk O, Bondad J, Szopiński T, Korzelik I, Borówka A - Arab J Urol (2015)

Start of the dissection of the rectovesical pouch.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563016&req=5

f0010: Start of the dissection of the rectovesical pouch.
Mentions: The patient was operated under general anaesthesia and placed in the Trendelenburg position. The trocar placements were similar to those for a laparoscopic radical prostatectomy. A 10-mm trocar was placed at the level of the umbilicus. Two 10-mm working trocars were inserted lateral to the rectus and just inferior to the umbilical trocar bilaterally. Two further 5-mm trocars were placed at the mid-clavicular line and medial to the anterior superior iliac spine bilaterally. The five-trocar configuration created a fan-shaped array (Fig. 1). Dissection was carried out from the superior part of the rectovesical pouch, then to the fascia posterior to the seminal vesicle, and down to Denonvilliers’ fascia (Fig. 2). After this, the endopelvic fascia was dissected bilaterally to gain access to the retropubic space. As a result, a ‘tunnel’ between the prostate and rectum is created in which a cuff with a specific length can be introduced (Fig. 3). The 0° laparoscope was used for most of the procedure, but a 30° laparoscope was necessary for the dissection of the prostate, for the measuring tape and the cuff. The diameter of the AUS that was required was measured using the measuring tape introduced via the right-sided 10-mm working port. The AUS (AMS 800) was subsequently implanted around the prostate (Fig. 4). A 5-cm lower midline incision was made to accommodate the insertion of the reservoir. All remaining parts of the AUS were placed and connected in a standard manner. The total duration of the procedure was 180 min and the estimated blood loss was 150 mL. There were no complications during or after the surgery. At 48 h after the procedure, the urinary catheter was removed and the patient was discharged from the hospital. The AUS was activated 1 month after surgery. After 1 year the patient maintained continence, with no accidental leakage reported and no malfunction problems with the device.

Bottom Line: There were no complications.After activating the AUS the patient was totally continent.The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Jagiellonian University, Cracow, Poland ; Department of Urology Medical Centre of Postgraduate Education, Warsaw, Poland ; Department of Urology, Institute of Oncology, Kielce, Poland.

ABSTRACT

Objective: To report the first laparoscopic periprostatic implantation of an artificial urinary sphincter (AUS) after a transurethral resection of the prostate.

Background: The implantation of an AUS is a standard procedure for severe urinary incontinence. In men it is usually implanted through a perineal approach, with the cuff placed around the bulbous urethra, bladder neck, or even around the prostate.

Method: We report a laparoscopic periprostatic implantation of an AUS after a transurethral resection of a prostate in a 72-year-old-man with incontinence.

Results: The operative duration was 180 min and the blood loss was 150 mL. There were no complications. After activating the AUS the patient was totally continent.

Conclusion: The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure.

No MeSH data available.


Related in: MedlinePlus