Introduction: Urinary incontinence after radical prostatectomy or pelvic radiotherapy is an usual disorder. First approach can be attempted with conservative therapies. If such management proves to be unsuccessful a surgical approach could be attempted. Surgical therapeutic options are the placement of Male Slings or Compression Devices. Even Though the artificial urinary sphincter (AUS) proved to be successfull and durable, many patients elect an urethral sling as the initial treatment of male stress incontinence. We assessed how the presence of previously implanted sling devices could modify the surgical technique of sphincter positioning. Methods: Since 2018, we have implanted 7 Artificial Sphincters. The average Age was 69.7 years. Three patients had previously undergone other surgeries for the management of urinary incontinence. They were carriers of male urethral slings. In two patients we decided to keep the previously implanted device in place, in one case it was removed. In this video we present the surgical technique performed in a 68 years old male patient who underwent Radical Prostatectomy and Pelvic radiation therapy . Total PSA 0.008 ng/ml (December 2021). In 2010, a Sling adVance trans-obturator was placed; the patient did not have any benefit (use of 4 pants per day). Therefore, in February 2022 implantation of AUS was performed; during surgery, the older device was removed. The sphincter was activated after a month from the procedure. Results: The patient recovered urinary continence. We performed an outpatient follow-up during the months. In October 2022 he reported loss of few drops of urine after physical effort but he stated that he had no need to use pads. Conclusions: Our belief is that artificial sphincter can be safely positioned in patients who have previously undergone urethral sling placement for management of urinary incontinence. Otherwise, the state of urethra needs assessing and removal of the previously implanted device must be decided on a case-by-case basis. If it is decided to keep in place the urethral sling, the sphincter cuff could be placed more distally, instead intra and post-operative complications are higher. SOURCE OF Funding: None
