Combined Anterior Transmembranous Posterior Urethral Bulbar (CATPUB) cuff placement: A novel surgical technique for AUS implantation after severe pelvic trauma - a retrospective cohort study.

Abstract

Background: Neurogenic urinary incontinence represents a major therapeutic challenge in patients with a history of severe pelvic trauma, where extensive scarring and distorted anatomy limit conventional surgical options. Despite its clinical relevance, published data on continence-preserving treatments for this subgroup remain scarce, and many patients are managed with permanent catheterization or urinary diversion.

Objective: Our aim was to describe a novel technique for artificial urinary sphincter implantation using an alternative cuff placement strategy around the bladder outlet and to evaluate associated clinical outcomes.

Design: Single-center retrospective cohort study evaluating feasibility, safety, and long-term outcomes of a novel surgical technique.

Methods: We provide a standardized, step-by-step description of the novel operating technique and retrospectively analyzed 12 consecutive paraplegic male patients who underwent artificial urinary sphincter implantation using this approach. Demographic, functional, and patient-reported outcomes were assessed.

Results: Twelve consecutive patients underwent successful implantation of an artificial urinary sphincter using the CATPUB (Combined Anterior Transmembranous Posterior Urethral Bulbar) technique between 2008 and 2025. No serious perioperative complications were observed during a follow-up of up to 15 years (median 35 months).

Conclusions: CATPUB cuff placement provides a safe and effective continence-preserving option for male paraplegic patients with neurogenic urinary incontinence following severe pelvic trauma and may represent a valuable alternative when conventional bladder neck cuff placement is not feasible.