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The penoscrotal approach is a viable alternative to the perineal approach for artificial urinary sphincter implantation: a retrospective cohort study

International Journal of Impotence Research (2025)Cite this article

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Abstract

The artificial urinary sphincter is the standard surgical treatment for persistent stress urinary incontinence in male patients when conservative methods fail, with the perineal approach being the most commonly used. However, the penoscrotal approach, which requires only a single incision, offers advantages such as shorter operation times and ease of execution, though concerns about lower dry rates and higher complication risks remain. This retrospective cohort study analyzed outcomes of 156 patients who underwent artificial urinary sphincter implantation via the penoscrotal approach between 2014 and 2024, excluding revision and double prosthesis cases. The mean patient age was 72.5 ± 6.8 years, a median cuff size of 4 cm (3.5–6), a mean operation time of 28.3 ± 8.7 min and a median follow-up of 27.6 (2.6–109.7) months. The most common immediate postoperative complication was urinary retention (5.8%). At six months, 65.4% of patients were completely dry, and 82.7% were socially continent. Revision was required in 32.1% of cases, aligning with literature-reported rates. This study suggests that the penoscrotal approach is a viable alternative to the perineal method, offering potential benefits in operative efficiency while maintaining comparable outcomes to the classic perineal approach.

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Fig. 1: Perineal incision for AUS implantation through perineal approach.
Fig. 2: Inguinal incision for AUS implantation through perineal approach.
Fig. 3: Penoscrotal incision for AUS implantation through penoscrotal approach.
Fig. 4: Dissection of proximal urethra through penoscrotal incision.

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Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to privacy reasons but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Urology, Jessa-UH, Hasselt, Belgium

    Lien Verbeke, Helene De Bruyn, Caroline Jamaer & Koenraad Van Renterghem

  2. Department of Urology, University Hospitals Leuven, Leuven, Belgium

    Lien Verbeke, Helene De Bruyn & Koenraad Van Renterghem

  3. Department of Urology, Maastricht University, Maastricht, The Netherlands

    Alexander Van Renterghem

  4. Department of Urology, Association Urology Hageland, Diest/Tienen/Leuven, Belgium

    Evert Baten

  5. University of Hasselt, Hasselt, Belgium

    Koenraad Van Renterghem

Authors
  1. Lien Verbeke
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  2. Helene De Bruyn
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  3. Caroline Jamaer
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  4. Alexander Van Renterghem
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  5. Evert Baten
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  6. Koenraad Van Renterghem
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Contributions

Lien Verbeke: Corresponding author, first author. Helene De Bruyn: Helped write the article. Caroline Jamaer: Provided feedback on the article. Alexander Van Renterghem: Provided feedback on the article. Evert Baten: Reviewed the article, Koenraad Van Renterghem: Senior author.

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Correspondence to Lien Verbeke.

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The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. Ethical approval: SATURN trial (NCT02757274). Informed consent for study participation was obtained from all participants. Written consent for publication of images was obtained.

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Verbeke, L., De Bruyn, H., Jamaer, C. et al. The penoscrotal approach is a viable alternative to the perineal approach for artificial urinary sphincter implantation: a retrospective cohort study. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01178-4

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