V1559: Combined therapy of stress urinary incontinence and erectile dysfunction with the implantation of Advance (XP) and AMS 700 in a single procedure

Video

Introduction and Objectives
After radical prostatectomy, urinary incontinence and erectile dysfunction (ED) may occur as post operative quality of life issues. Patients may wish that both problems can be resolved and treated with a single surgical procedure. We report a multi-center experience of synchronous placement of a transobturator bulbourethral male sling (AdVance™ or AdVance XP™) and an inflatable penile prosthesis (IPP, AMS 700™).

Methods
24 patients with ED and mild-to-moderate post prostatectomy stress urinary incontinence underwent a combined 3-piece IPP and AdVance (XP) male sling implantation. Patient selection was strict: all had failed previous conservative therapy for ED and were using 3 pads per day. Urethras were naïve: no patient had received radiation, urethral injection or incision. The sling procedure was first performed and then the IPP without a change in the patient's position. Patients were followed from 2 months to 3 years.

Results
No intraoperative complications occured. One patient died of pulmonary embolism prior to catheter removal. 7 patients (29%) had transient urinary retention requiring 3-5 days of indwelling catheter drainage. 21 of 24 patients (88%) were dry without pad usage. Within the follow up period, continual pad usage (1-2 pads/24hours) was reported by 2 patients (8%) and one patient (4%) later underwent single-cuff artificial urinary sphincter implantation. All patients are currently utilizing their penile prosthesis.

Conclusions
The transobturator bulbourethral sling and IPP implantation can be safely and effectively performed in a single surgical procedure with good results.

Funding: Video animation was supported with an unrestricted scientific grant from American Medical Systems, Inc..