Faysal A. Yafi1, Ashley Richman1, Taylor Peak1, Gregory Mitchell1, Wayne J.G. Hellstrom1
1: Tulane University School of Medicine
Introduction: Current gold standard of care therapies for patients with significant post-prostatectomy erectile dysfunction (ED) and stress urinary incontinence (SUI) are the inflatable penile prosthesis (IPP) and the artificial urinary sphincter (AUS).
Case presentation: This is a 72 year old diabetic man who underwent robotic assisted radical prostatectomy 3 years ago. Surgical margins were negative and the patient has not had any biochemical recurrence. He has post-operative ED which is refractory to medications and vacuum erection device, and SUI requiring 5-6 pads/day.
Protocol: The patient is placed in supine position and a 2cm penoscrotal incision is performed. The AUS is routinely placed first. Using adequate retraction, the cuff is placed proximally at the level of the bulb. The pressure regulating balloon is placed in the right space of Retzius. The hooks are then repositioned and the IPP cylinders are placed. The IPP reservoir is placed in the left space of Retzius. Both pumps are placed on opposite sides of the scrotum.
Outcome: Three months post-operatively, the patient reports good functionality of IPP and ability to have intercourse. Patient also reports no residual urinary leakage. Both patient and partner are very satisfied with outcomes.
Discussion: Dual synchronous AUS/IPP insertion through a single penoscrotal incision is a safe and cost/time-efficient procedure which can yield excellent results.