Infla10® Pulse™Also Known As
Transcorporal artificial urinary sphincter implantation, TC-AUS placement, Transcorporal cuff placement, TC approach
Definition
The transcorporal approach is a specialized surgical technique used in urological procedures, particularly for artificial urinary sphincter (AUS) implantation, where the cuff is placed through the corpora cavernosa of the penis1. This technique involves making longitudinal incisions into the tunica albuginea of both corpora cavernosa, lateral to the urethra, followed by blunt dissection to create a tunnel inside the corpora cavernosa2. The cuff is then placed through this tunnel, encircling the urethra with corporal tissue as a protective layer3. This approach is primarily used as a salvage option in patients with fragile urethras, such as those with previous failed AUS implantation, urethral atrophy, erosion, or history of pelvic radiation therapy4.
Clinical Context
The transcorporal approach is primarily indicated in challenging cases of male stress urinary incontinence (SUI), particularly in patients with fragile urethras1. Specific clinical scenarios include:
1. Patients with a history of failed previous artificial urinary sphincter implantation due to urethral erosion or atrophy2
2. Patients who have undergone bulbar urethroplasty3
3. Patients with severe urethral atrophy after pelvic radiation therapy1
4. As a salvage surgical procedure after failure of previous anti-incontinence surgery1
The procedure is performed under general anesthesia with the patient in lithotomy position. A midline perineal incision is made, followed by dissection to expose the urethra and adjacent corpora cavernosa2. The cuff placement is typically 2-3 cm distal to the original cuff location or site of urethroplasty2.
Patient selection criteria include those with moderate-to-severe stress urinary incontinence who have failed conservative treatment and have a history of urethral compromise4. The procedure has shown good outcomes in terms of continence rates, with studies reporting social continence rates (0-1 pads per day) of approximately 78-83% at 12 months3.
A significant consideration with the traditional transcorporal approach is the potential impact on erectile function due to the necessary injury of the corpora cavernosa2. However, studies have shown that erectile function can be maintained in some patients despite dissection of the corporal body1. Recent modifications to the technique, such as the Gullwing Technique and transalbugineal approach, aim to better preserve erectile function while maintaining the protective benefits for the urethra3,4.