V04-05: Single Perineal Incision for Artificial Urinary Sphincter and Semi-Rigid Penile Prosthesis Placement
Robotic Assisted Radical Prostatectomy (RALP) has improved the treatment of patients with prostate cancer in comparison with previous open techniques. Unfortunately, stress urinary incontinence (SUI) and erectile dysfunction (ED) are still common side effects from these procedures and have a significant impact on the quality of life of patients. Prosthesis have been created for treatment of SUI, being the artificial urinary sphincter (AUS) one of the most successful approaches. Penile prosthesis, both inflatable and semi-rigid (SRPP) have also been used for ED treatment on patients that underwent prostate surgery with very high satisfaction rates. The combination of SUI and ED is high after RALP and a combined approach for treatment of those issues has been discussed. We present an option for single incision placement of AUS and SRPP.
We present a case of an 82 years old gentleman who underwent RALP and salvage external beam radiation for prostate cancer. After surgery, he developed severe ED (refractive to oral and intracavernous medications) and SUI (requiring more than 4 pads/day). Being extremely active, he was interested on surgical options for treatment of both conditions, preferring a single surgery and incision. After being counseled on options and having a cystoscopy done, revealing no urethral abnormalities, he underwent the procedure described in the video.
Surgery was uneventful and so was his post-op course. A AMS 800 AUS® combined with a AMS Spectra® 12cmx12mm SRPP was placed, both through the same perineal incision. Patient was discharge on POD1 with no complications. He had his AUS activated 6 weeks after surgery and reported good urinary control, with very mild stress incontinence and easy pump control. He did not resume sexual activity yet. No surgical complications were seen.
The surgical treatment of SUI and ED after RALP can be safely performed by a single perineal incision, and this can reduce the surgical morbidity for those patients, as well as the required hospital stay, reduced opioid intake and without evidence of increased infection of other complications related to prosthetic surgery. The combined AUS and penile prosthesis surgery is well known in the prosthetic urology field and we believe that our single incision approach can offer significant benefits for the patient in the post-operative setting, but a larger group study is needed to consolidate this findings.