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Also known as
Tandem cuff placement, Tandem cuff technique, Double cuff artificial urinary sphincter, Dual cuff technique, Tandem urethral cuff placement
Definition
The Double-Cuff Technique is a specialized surgical method used in artificial urinary sphincter (AUS) implantation that involves placing two occlusive cuffs around the bulbar urethra to enhance urinary continence outcomes in patients with severe stress urinary incontinence.1 This technique was first described by Brito et al. in 1993 as a solution for patients who continued to experience significant wetness despite having a single cuff AUS.1 In this approach, a second cuff is typically placed 1-2 cm distal to the primary cuff, with both cuffs connected to a single control pump and pressure-regulating balloon using a Y-shaped adapter.3 The dual circumferential compression points created by the two cuffs are intended to enhance urethral coaptation in patients with severe incontinence.1 Additional fluid (1-3cc) is added to the system to account for the volume sequestered in the second cuff.3 In the original small series, this technique was reported to increase the success rate of artificial urinary sphincter implantation to greater than 95%, although long-term comparative data have not shown better continence than with a single cuff.1
Clinical Context
The Double-Cuff Technique is primarily indicated for patients with severe stress urinary incontinence who are almost totally incontinent before artificial sphincter implantation.1 Approximately 15% of patients treated with a single cuff AUS continue to experience significant wetness despite some improvement, making them candidates for this approach.1 The technique is also utilized as a revision strategy for patients with urethral atrophy at the original cuff site, which is one of the most common causes of non-mechanical failure or device revision.3
The surgical procedure involves careful placement of the second cuff approximately 1-2 cm distal to the primary cuff, with an adequate space of about 1 cm between the two cuffs.3 A Y-shaped adapter, secured with free ties of non-absorbable suture, connects the pump tubing to both cuffs.3 In cases of severely atrophic urethral tissues (measurement <3.5cm), distal urethral tapering, or difficult dissection planes (e.g., in patients with prior pelvic radiation therapy), a transcorporal approach may be utilized in conjunction with the double-cuff configuration.3
In revisions for urethral atrophy, one study found no significant difference in 3-year overall device survival between single cuff and tandem cuff revisions (60% versus 76%, p=0.94).2 However, men receiving double cuff implants may be at higher risk of complications requiring additional surgery.2 The original series reported a success rate greater than 95% with the Double-Cuff Technique in selected patients, but long-term comparative studies have not confirmed better continence than with a single cuff.1