Zephyr 375 urinary sphincter implant by unical perineal incision. Initial experience

Implante de esfinter urinario artificial zephyr 375 mediante incisión perineal única. Experiencia inicial

The treatment of male severe stress incontinence (MUI) after surgery is the implantation of an artificial urinary sphincter (AUS). Traditionally you need two incisions: perineal and inguinal. Our objetive is present a series of patients treated with the Zephyr 375 EUA implant through a single perineal incision. We present six men operated on for MUI after Transuretral resection of the prostate (TURP) (1) and radical prostatectomy (5). Preoperatively we perform Pad-Test and cystoscopy. Under epidural anesthesia, a vertical perineal incision was made and dissection up to the bulbospongiosus muscle was divided and we dissected the bulbar urethra. After removing the probe, we place the cuff, checking that it reaches the appropriate pressure, leaving it deactivated. To place the pump-reservoir, we digitally develop a scrotal dartos pocket from the perineum that we close with Vicryl 3/0. After closing the muscle with 3/0 Vicryl, we left a suction drain and a bladder catheter. The mean age was 63 years (55–72). Mean surgical time was 68 minutes (60–85). All were discharged the next day without catheter and drain. All patients comfortably palpated the scrotal reservoir-pump. After activation, all patients were continent without needing additional adjustment, using 3 a safety pad. The degree of satisfaction was very high, all of them affirmed that they would undergo the same intervention again. The Zephyr 375 urinary sphincter allows placement through a single perineal incision, reducing surgical time, simplifying the technique, and reducing morbidity without compromising the functional outcome.

Resumen

El tratamiento de la incontinencia de esfuerzo severa masculina (IUM) tras cirugía es el implante de un esfínter urinario artificial (EUA). Tradicionalmente necesita dos incisiones: perineal e inguinal. Nuestro objetivo es presentar una serie de pacientes tratados mediante implante de EUA Zephyr 375 por incisión perineal única. Presentamos seis varones intervenidos por IUM tras reseccion transuretral de próstata (RTUp) (1) y prostatectomía radical (5). Preoperatoriamente realizamos Pad-Test y cistoscopia. Bajo anestesia epidural, se realizó incisión vertical perineal y disección hasta el músculo bulbo esponjoso que se divide y disecamos la uretra bulbar. Tras retirar la sonda, colocamos el manguito, comprobando que alcanza la presión adecuada, quedando desactivado. Para colocar la bomba-reservorio, desarrollamos digitalmente desde el periné un bolsillo de dartos escrotal que cerramos con Vicryl 3/0. Tras cerrar el músculo con Vicryl 3/0 dejamos un drenaje aspirativo y una sonda vesical. La edad media de edad fue 63 años (55–72). El tiempo quirúrgico medio fue 68 minutos (60–85). Todos fueron dados de alta al día siguiente sin sonda ni drenaje. Todos los pacientes se palpaban cómodamente la bomba-reservorio escrotal. Tras la activación, todos los pacientes quedaron continentes sin necesitar ajuste adicional, utilizando 3 una compresa de seguridad. El grado de satisfacción fue muy alto, todos afirmaron que se someterían de nuevo a la misma intervención. El esfínter urinario Zephyr 375 permite la colocación mediante una sola incisión perineal disminuyendo el tiempo quirúrgico, simplificando la técnica y reduciendo la morbilidad sin menoscabo del resultado funcional.

Incontinence; Urinary artificial esphinter; Radical prostatectomy

Palabras Clave

Incontinencia; Esfínter urinario; Prostatectomía radical

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