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Also known as
TC cuff, Transcorporal AUS cuff, Transcorporal artificial urinary sphincter cuff, Transalbugineal cuff, Transcorporeal urethral cuff, TC technique
Definition
The Transcorporeal Cuff is a specialized artificial urinary sphincter (AUS) cuff placement technique in which the cuff is positioned through the corpus cavernosum for revision cases of urinary incontinence.1 This surgical approach involves creating a tunnel through a portion of the corpora cavernosa to allow circumferential compression of the urethra while avoiding direct posterior urethral dissection.2 The technique was first described in 2002 as a salvage procedure for patients with compromised urethras, particularly those with prior urethral erosion, radiation, or urethroplasty.3
In the transcorporeal technique, bilateral corporotomies are performed, and the cuff is placed around both the urethra and a portion of the tunica albuginea of the corpora cavernosa.4 This provides additional tissue bulk between the cuff and the urethra, which helps protect the posterior aspect of the urethra during dissection and potentially reduces the risk of subsequent erosion in high-risk patients.5 The procedure is primarily utilized in cases where standard bulbar urethral cuff placement is challenging or contraindicated due to prior surgical interventions or tissue damage.6
Clinical Context
The Transcorporeal Cuff is primarily utilized in specific clinical scenarios involving male stress urinary incontinence (SUI) where standard artificial urinary sphincter (AUS) placement is challenging or contraindicated.1 These scenarios include:
1. Revision surgeries
In patients who have experienced previous AUS cuff erosion or mechanical failure requiring device removal and replacement.2 The transcorporeal approach provides additional tissue bulk between the cuff and urethra, potentially reducing the risk of recurrent erosion.3
2. Compromised urethras
In patients with urethral atrophy, prior urethroplasty, or radiation-induced tissue damage where the standard bulbar urethral dissection may be difficult or dangerous.4 The technique is particularly valuable in patients who have undergone pelvic radiation therapy, which can cause tissue fibrosis and poor vascularity.5
3. Salvage procedures
As a salvage option when other incontinence treatments have failed, especially in high-risk patients with multiple prior surgeries or radiation.6
The procedure is performed under general anesthesia through a perineal approach. After exposure of the bulbar urethra, bilateral corporotomies are created, and the cuff is placed through the corporal bodies, encompassing both the urethra and a portion of the tunica albuginea.1 This technique avoids the need for circumferential urethral mobilization, which can compromise urethral blood supply in already vulnerable tissue.4
Outcomes data show that the transcorporeal approach provides satisfactory continence rates (69-88% achieving social continence) in these challenging cases.2 However, studies comparing transcorporeal cuffs to standard or 3.5 cm cuffs have shown potentially higher erosion rates with the transcorporeal technique over long-term follow-up.5 The procedure may also impact erectile function in potent patients, as it involves dissection through the corpora cavernosa.6 Therefore, patient selection and counseling regarding potential complications and expectations are essential components of clinical decision-making.