{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T22:17:21Z","timestamp":1788041841215,"version":"build-2784847793"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T00:00:00Z","timestamp":1682035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The artificial urinary sphincter (AUS) implantation is an effective treatment of post-prostatectomy urinary incontinence (PPI). Still, it may result in troublesome complications such as intraoperative urethral lesion and postoperative erosion. Based on the multilayered structure of the tunica albuginea of the corpora cavernosa, we evaluated an alternative transalbugineal surgical technique of AUS cuff placement with the aim to decrease perioperative morbidity while preserving the integrity of the corpora cavernosa. A retrospective study was conducted in a tertiary referral center from September 2012 to October 2021, including 47 consecutive patients undergoing AUS (AMS800\u00ae) transalbugineal implantation. At a median (IQR) follow-up of 60 (24\u201384) months, no intraoperative urethral injury and only one noniatrogenic erosion occurred. The actuarial 12 mo and 5 yr overall erosion-free rates were 95.74% (95% CI: 84.04\u201398.92) and 91.76% (95% CI: 75.23\u201397.43), respectively. In preoperatively potent patients, the IIEF-5 score remained unchanged. The social continence (0\u20131 pads per day) rate was 82.98% (CI 95%: 68.83\u201391.10) at 12 mos and 76.81% (CI 95%: 60.56\u201387.04) at 5 yrs follow-up. Our technically refined approach to AUS implantation may help to avoid intraoperative urethral lesions and lower the risk of subsequent erosion without compromising sexual function in potent patients. Prospective and adequately powered studies are necessary to achieve more compelling evidence.<\/jats:p>","DOI":"10.3390\/jcm12083021","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T04:48:11Z","timestamp":1682052491000},"page":"3021","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Transalbugineal Artificial Urinary Sphincter: A Refined Implantation Technique to Improve Surgical Outcomes"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-8354","authenticated-orcid":false,"given":"Emilio","family":"Sacco","sequence":"first","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2908-6907","authenticated-orcid":false,"given":"Filippo","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1349-7696","authenticated-orcid":false,"given":"Carlo","family":"Gandi","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0757-152X","authenticated-orcid":false,"given":"Riccardo","family":"Bientinesi","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Totaro","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3418-5202","authenticated-orcid":false,"given":"Stefano","family":"Moretto","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9994-4316","authenticated-orcid":false,"given":"Filippo","family":"Gavi","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7412-1214","authenticated-orcid":false,"given":"Marco","family":"Campetella","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9129-8479","authenticated-orcid":false,"given":"Marco","family":"Racioppi","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.urology.2009.11.078","article-title":"Epidemiology Committee of the Fourth International Consultation on Incontinence, Paris, 2008. Prevalence of urinary incontinence in men, women, and children-current evidence: Findings of the Fourth International Consultation on Incontinence","volume":"76","author":"Buckley","year":"2010","journal-title":"Urology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1111\/j.1464-410X.2006.06185.x","article-title":"Urinary incontinence after radical prostatectomy: Incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up","volume":"97","author":"Sacco","year":"2006","journal-title":"BJU Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100191","DOI":"10.1016\/j.cont.2022.100191","article-title":"Prospective multi center registry for patients undergoing surgery for male stress urinary incontinence (SATURN): 1 year follow-up in 500 patients","volume":"2","author":"Martens","year":"2022","journal-title":"Continence"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5301\/uro.5000103","article-title":"Chirurgia dell\u2019incontinenza urinaria maschile: A che punto siamo? [Surgery for male urinary incontinence: Where are we now and what is in the pipeline?]","volume":"82","author":"Bientinesi","year":"2015","journal-title":"Urologia"},{"key":"ref_5","unstructured":"Gravas, S., Cornu, J.N., Gacci, M., Gratzke, T.R.W., Hermann, S., Madersbacher, C., Mamoulakis, K.A.O., Tikkinen, M., Karavitakis, I., and Kyriazis, S. (2022, November 20). European Association of Urology (EAU) Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). Available online: https:\/\/uroweb.org\/guidelines\/management-of-non-neurogenic-male-luts."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/bju.15197","article-title":"Artificial urinary sphincter significantly better than fixed sling for moderate post-prostatectomy stress urinary incontinence: A propensity score-matched study","volume":"127","author":"Sacco","year":"2021","journal-title":"BJU Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/0090-4295(73)90749-8","article-title":"Treatment of urinary incontinence by implantable prosthetic sphincter","volume":"1","author":"Scott","year":"1973","journal-title":"Urology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.euf.2017.11.007","article-title":"Surgical Treatment of Male Postprostatectomy Incontinence: Current Concepts","volume":"3","author":"Kretschmer","year":"2017","journal-title":"Eur. Urol. Focus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"536","DOI":"10.5489\/cuaj.924","article-title":"The artificial urinary sphincter is the treatment of choice for post-radical prostatectomy incontinence","volume":"2","author":"Herschorn","year":"2008","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_10","first-page":"180","article-title":"Evaluation and surgical management of intrinsic sphincter deficiency after radical prostatectomy","volume":"6","author":"Flynn","year":"2004","journal-title":"Rev. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.urology.2011.11.051","article-title":"Long-term outcomes after primary failures of artificial urinary sphincter implantation","volume":"79","author":"Wang","year":"2012","journal-title":"Urology"},{"key":"ref_12","unstructured":"Smith, J.A., Howards, S.S., Preminger, G.M., and Dmochowski, R.R. (2017). Hinman\u2019s Atlas of Urologic Surgery, Elsevier. [4th ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1016\/S0022-5347(05)65088-4","article-title":"Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy","volume":"167","author":"Guralnick","year":"2002","journal-title":"J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1111\/bju.12386","article-title":"Transcorporal artificial urinary sphincter implantation as a salvage surgical procedure for challenging cases of male stress urinary incontinence: Surgical technique and functional outcomes in a contemporary series","volume":"112","author":"Wiedemann","year":"2013","journal-title":"BJU Int."},{"key":"ref_15","first-page":"e25519","article-title":"Outcomes of Initial Transcorporal Versus Standard Placement of Artificial Urinary Sphincter in Patients With Prior Radiation","volume":"31","author":"Miller","year":"2022","journal-title":"Cureus"},{"key":"ref_16","first-page":"6773","article-title":"Transcorporal artificial urinary sphincter cuff placement is associated with a higher risk of postoperative urinary retention","volume":"20","author":"Smith","year":"2013","journal-title":"Can. J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/S0022-5347(01)65359-X","article-title":"The anatomy of the tunica albuginea in the normal penis and Peyronie\u2019s disease","volume":"157","author":"Brock","year":"1997","journal-title":"J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/01485010500203667","article-title":"Histologic study of the tunica albuginea of the penis and mode of cavernosus muscles\u2019 insertion in it","volume":"52","author":"Shafik","year":"2006","journal-title":"Arch. Androl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.urology.2004.01.005","article-title":"International consultation on incontinence questionnaire short form: Comparison of physician versus patient completion and immediate and delayed self-administration","volume":"63","author":"Hajebrahimi","year":"2004","journal-title":"Urology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual. Life Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1038\/sj.ijir.3900472","article-title":"Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction","volume":"11","author":"Rosen","year":"1999","journal-title":"Int. J. Impot Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1111\/j.1464-410X.2008.07872.x","article-title":"The artificial genitourinary sphincter","volume":"102","author":"Stoffel","year":"2008","journal-title":"BJU Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1111\/iju.12392","article-title":"Artificial urinary sphincter for post-prostatectomy incontinence: A review","volume":"21","author":"James","year":"2014","journal-title":"Int. J. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.urology.2018.02.022","article-title":"Titanized Transobturator Sling Placement for Male Stress Urinary Incontinence Using an Inside-out Single-incision Technique: Minimum 12-Months Follow-up Study","volume":"115","author":"Sacco","year":"2018","journal-title":"Urology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.eururo.2022.05.012","article-title":"European Association of Urology Guidelines on Male Urinary Incontinence","volume":"82","author":"Gacci","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.eururo.2012.11.034","article-title":"Young Academic Urologists Functional Urology Group. The artificial urinary sphincter after a quarter of a century: A critical systematic review of its use in male non-neurogenic incontinence","volume":"63","author":"Drake","year":"2013","journal-title":"Eur. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/bju.14476","article-title":"Dorsolateral fibromuscular tissue preservation during artificial urinary sphincter cuff placement is associated with low infection and erosion rates","volume":"123","author":"Cheung","year":"2019","journal-title":"BJU Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1097\/JU.0000000000001148","article-title":"Artificial Urinary Sphincter Cuff Erosion Heat Map Shows Similar Anatomical Characteristics for Transcorporal and Standard Approach","volume":"204","author":"Ortiz","year":"2020","journal-title":"J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/j.juro.2018.06.069","article-title":"Impact of Radiation and Transcorporeal Artificial Sphincter Placement in Patients with Prior Urethral Cuff Erosion: Results from a Retrospective Multicenter Analysis","volume":"200","author":"Moser","year":"2018","journal-title":"J. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.urology.2014.05.043","article-title":"Risk factors for erosion of artificial urinary sphincters: A multicenter prospective study","volume":"84","author":"Brant","year":"2014","journal-title":"Urology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1016\/j.juro.2014.06.088","article-title":"Artificial urinary sphincter placement in compromised urethras and survival: A comparison of virgin, radiated and reoperative cases","volume":"192","author":"McGeady","year":"2014","journal-title":"J. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"682","DOI":"10.21037\/tau.2017.07.31","article-title":"Artificial urinary sphincter","volume":"6","author":"Brant","year":"2017","journal-title":"Transl. Androl. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"918011","DOI":"10.3389\/fsurg.2022.918011","article-title":"Transcroporal Artificial Urinary Sphincter Placement with Closure of Corporal Bodies\u2014A Long-Term Analysis of Functional Outcomes","volume":"1","author":"Maurer","year":"2022","journal-title":"Front. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1111\/j.1442-2042.2012.03034.x","article-title":"Intermediate outcomes after transcorporal placement of an artificial urinary sphincter","volume":"19","author":"Lee","year":"2012","journal-title":"Int. J. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1002\/nau.23119","article-title":"Prospective follow-up study of artificial urinary sphincter placement preserving the bulbospongiosus muscle","volume":"36","author":"Serra","year":"2017","journal-title":"Neurourol. Urodyn."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.juro.2017.08.077","article-title":"Surgical and Patient Reported Outcomes of Artificial Urinary Sphincter Implantation: A Multicenter, Prospective, Observational Study","volume":"199","author":"Kaiho","year":"2018","journal-title":"J. Urol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.juro.2006.10.062","article-title":"13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine","volume":"177","author":"Lai","year":"2007","journal-title":"J. Urol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.urology.2007.09.009","article-title":"A prospective study evaluating the efficacy of the artificial sphincter AMS 800 for the treatment of postradical prostatectomy urinary incontinence and the correlation between preoperative urodynamic and surgical outcomes","volume":"71","author":"Rocha","year":"2008","journal-title":"Urology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1111\/bju.13399","article-title":"Impact of frailty on complications in patients undergoing common urological procedures: A study from the American College of Surgeons National Surgical Quality Improvement database","volume":"117","author":"Suskind","year":"2016","journal-title":"BJU Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4103\/aja.aja_110_19","article-title":"Management of urethral atrophy after implantation of artificial urinary sphincter: What are the weaknesses?","volume":"22","author":"Heah","year":"2020","journal-title":"Asian J. Androl."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1016\/j.juro.2008.01.048","article-title":"Long-term durability and functional outcomes among patients with artificial urinary sphincters: A 10-year retrospective review from the University of Michigan","volume":"179","author":"Kim","year":"2008","journal-title":"J. Urol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E69","DOI":"10.1111\/bju.14566","article-title":"Patient pad count is a poor measure of urinary incontinence compared with 48-h pad test: Results of a large-scale multicentre study","volume":"123","author":"Sacco","year":"2019","journal-title":"BJU Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/3021\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:20:31Z","timestamp":1760124031000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/3021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,21]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcm12083021"],"URL":"https:\/\/doi.org\/10.3390\/jcm12083021","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,21]]}}}