INFLATABLE PENILE PROSTHESIS AND ‘MINI MALE URETHRAL SLING’ PLACEMENT FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND CLIMACTURIA
A &[prime]mini male sling&[prime] (MMS) is a urethral sling designed to treat climacturia, urinary incontinence at the time of ejaculation. The MMS is composed of either human cadaveric pericardium or macroporous monofilament polypropylene mesh and is sutured to the ventral bilateral corpora cavernosa proximal to the corporotomies for inflatable penile prosthesis (IPP) placement at the level of the bulbar urethra. For men who experience erectile dysfunction and climacturia, we hypothesized that placement of an IPP and a MMS would result in significant improvement in patient-reported climacturia and mild stress urinary incontinence as measured by pad use.
A retrospective review was performed for all consecutive patients (n=14) who underwent IPP and MMS placement by a single surgeon between 2016-2017. Patient-reported climacturia and number of pads used daily for mild stress urinary incontinence were assessed pre-operatively and at each post-operative visit starting at 2 post-operative weeks for mild stress urinary incontinence and starting at 3 post-operative months for climacturia. Pre-operative to post-operative patient reported climacturia and pad use were compared for each patient using McNemar&[prime]s test with a statistical significance threshold of p<0.05. </p>
Fourteen men underwent both IPP and MMS placement (11 concomitant IPP/MMS, 3 sequential IPP/MMS). Mean patient age was 71 (SD 7.29) years, mean patient BMI was 26.23 (SD 3.27), mean IPP cylinder size was 19.8 (SD 2.2) cm, and mean MMS surface area was 14.0 (SD 1.78) cm2. 10 of the MMS were composed of macroporous monofilament polypropylene mesh; 4 were composed of human cadaveric pericardium. Mean post-operative follow-up was 2.29 (SD 1.90) months. Of the 9 patients who reported using 1 pad/day for mild stress urinary incontinence pre-operatively, 6 reported use of 0 pads/day by 2 post-operative weeks (McNemar significance probability=0.03). Of the 7 patients that reached the 3 month post-operative patient-reported climacturia assessment, all reported resolution of the climacturia (McNemar significance probability=0.02).
For men who experienced erectile dysfunction as well as climacturia and mild stress urinary incontinence, placement of a MMS at the time of IPP placement or thereafter significantly improved mild stress urinary incontinence as measured by pad use by 2 post-operative weeks and patient-reported climacturia by 3 post-operative months.