Ectopic low submuscular pressure regulating balloon placement with transfascial fixation for artificial urinary sphincter

INTRODUCTION: To present our novel low submuscular (LSM) pressure regulating balloon (PRB) placement for artificial urinary sphincter (AUS) technique as an alternative to standard approaches with patient-reported satisfaction outcomes. MATERIAL AND METHODS: A retrospective review was conducted on patients who underwent an AUS implantation using the LSM PRB placement with transfascial fixation technique from July 2019 to August 2020. Preoperative characteristics were collected. Patients then conducted a postoperative phone interview using an adapted questionnaire to assess satisfaction of device and PRB concealment. RESULTS: During the study period, nine patients had undergone AUS placement using the LSM technique by a single surgeon at our private institution. Eight of the nine patients had undergone a radical prostatectomy while the ninth patient developed stress urinary incontinence after radiation treatment for prostate cancer. All patients were 'very satisfied' with PRB placement and concealment with no patients endorsing PRB complications. The majority of patients (78%) were satisfied with the device. One patient was able to palpate the PRB while another patient endorsed mild soreness around the PRB. No surgical revisions were required and there were no surgical complications such as bowel obstruction, herniations, bladder erosions, or vascular injuries. CONCLUSION: LSM placement of AUS PRB with transfascial fixation offers an improved technique for balloon placement with decreased risk for complications. This can be performed as a safe, alternative approach to current standard techniques with a high degree of patient satisfaction.