In comparing the tape mechanical occlusive device (TMOD) with the artificial urinary sphincter, the authors mention that the narrow width of the occlusion tape requires less dissection around the bulbar urethra. They believe this might reduce the risk of urethral injury during urethral mobilization, and this, in turn, might encourage more urologists to use this device. Early urethral erosion after artificial urinary sphincter implantation almost always results from injury to the urethra during its mobilization. I believe this occurs when a right-angle clamp is placed behind the urethra to perforate the attachments to the tissue behind it. When the clamp is spread, these attachments sometimes tear off the back wall of the urethra, resulting in cuff erosion. A safer practice is to mobilize a longer segment of urethra, such that by rotating the urethra, the posterior attachments can be taken down sharply under direct vision. The move to a narrow tape and less urethral dissection might actually increase the risk of urethral injury. I believe that the TMOD could be safely implanted, but I would use the approach I have outlined.
展开▼
