The penoscrotal approach is a viable alternative to the perineal approach for artificial urinary sphincter implantation: a retrospective cohort study

The artificial urinary sphincter is the standard surgical treatment for persistent stress urinary incontinence in male patients when conservative methods fail, with the perineal approach being the most commonly used. However, the penoscrotal approach, which requires only a single incision, offers advantages such as shorter operation times and ease of execution, though concerns about lower dry rates and higher complication risks remain. This retrospective cohort study analyzed outcomes of 156 patients who underwent artificial urinary sphincter implantation via the penoscrotal approach between 2014 and 2024, excluding revision and double prosthesis cases. The mean patient age was 72.5 +/- 6.8 years, a median cuff size of 4 cm (3.5-6), a mean operation time of 28.3 +/- 8.7 min and a median follow-up of 27.6 (2.6-109.7) months. The most common immediate postoperative complication was urinary retention (5.8%). At six months, 65.4% of patients were completely dry, and 82.7% were socially continent. Revision was required in 32.1% of cases, aligning with literature-reported rates. This study suggests that the penoscrotal approach is a viable alternative to the perineal method, offering potential benefits in operative efficiency while maintaining comparable outcomes to the classic perineal approach.