Simultaneous placement of Inflatable Penile Prosthesis and Artificial Urinary Sphincter following radical prostatectomy via penoscrotal approach: A Step-by-Step Surgical Technique

Abstract

Introduction and ObjectiveErectile dysfunction and urinary incontinence are the most common sequelae after radical prostatectomy surgery. Inflatable penile prosthesis (IPP) and Artificial Urinary Sphincter (AUS) placement are common surgical treatment options following conservative and medical treatment. Often these procedures require specific surgical expertise to improve patients’ quality of life and maximize outcomes. In select cases, patients require the treatment of both conditions either simultaneously or staged approach. To this extent, we acknowledged the paucity of high-quality surgical videos addressing the surgical nuance of simultaneous IPP and AUS implantation (1500). In this video, we aim to highlight a step-by-step surgical technique of IPP and AUS implantation. MethodsThe patient is a 76-year-old African American male with a history of prostate cancer status post radical prostatectomy in 2019 complicated with PSA recurrence required subsequent external beam radiotherapy and androgen deprivation therapy with no evidence of disease recurrence at the time of the procedure. The patient presented to our cancer survivorship urologic clinic with bothersome Stress Urinary Incontinence (SUI) and medically refractory Erectile Dysfunction (ED) that failed prior therapeutic modalities as per AUA guidelines. After a thorough discussion of the risks, benefits, and potential complications, the patient elected to proceed with simultaneous IPP and AUS implantation via penoscrotal approach. During the procedure, we elected to first implant the AUS given the surgeon's preference and risk of the procedure. Following the successful placement of AUS, we proceeded to the IPP implantation. The corporotomy was made distally to the level of the AUS cuff to avoid damage and the IPP reservoir was placed on the contralateral side of the abdomen, opposite AUS pressure-regulating balloon. ResultsThe surgery was completed without complication and both the IPP and AUS were cycling well at the end of the surgery. At 6 weeks of clinic follow-up, the patient's devices were cycling properly, and the patient noted good erectile function and remarkable improvement in urinary continence. ConclusionsIn select patients, a simultaneous IPP and AUS implantation can be a viable option for patients with bothersome ED and SUI.