Post-prostatectomy stress urinary incontinence (SUI) significantly affects quality of life. Artificial urinary sphincter (AUS) insertion remains the gold standard treatment. The transperineal approach is a well-established method that offers excellent visualization and precise cuff placement. This video demonstrates the transperineal technique for AUS placement in a patient with SUI following radical prostatectomy.

The patient had persistent moderate-to-severe SUI following radical prostatectomy. A transperineal approach was selected for AUS placement due to favorable tissue quality and absence of prior pelvic radiation. The procedure was performed under general anesthesia in the lithotomy position. Step-by-step surgical dissection, identification of the bulbar urethra, cuff measurement, and device placement are demonstrated.

The surgery proceeded without complications. The perineal exposure allowed for optimal visualization of the urethra, safe dissection, and accurate cuff sizing. The pump was placed in the scrotum and the pressure-regulating balloon in the prevesical space. The patient had an uneventful recovery and was activated at 6 weeks with significant improvement in continence.

The transperineal approach for AUS insertion provides excellent access and control in non-irradiated patients with post-prostatectomy incontinence. This video serves as a valuable resource for urologists refining their technique in AUS placement.