Authors: Perry Xu, Farouk M. El-Khatib, Zhamshid Okhunov, Rajender Archana, Gamal Ghoneim, Faysal A. Yafi
Key words: Retrograde leak point pressure, climacturia, incontinence, mini-jupette, penile prosthesis
Climacturia may be present in 20% to 48% of men who have undergone radical prostatectomy . Concomitant Mini-Jupette placement with Inflatable Penile Prosthesis (IPP) insertion may reduce minimal stress urinary incontinence (SUI) and climacturia. Retrograde Leak Point Pressure (RLPP) is shown to be an objective measure of urethral resistance to flow and is validated in male anti-incontinence surgeries. A series of 13 men who received a Virtue male sling, median RLPP was recorded at 41 cm H2O, and results showed complete resolution of their incontinence . In our study, we sought to assess the RLPP achieved with inflation of the penile prosthesis with the Mini-Jupette in place. In our patient, the initial RLPP recorded was 15cm H2O (detailed explanation in the video). After Mini-Jupette sling placement and IPP inflation, RLPP increased significantly to 44 cm H2O. Complete urethral coaptation was demonstrated visually with cystoscopy. This is the fourth case performed using this technique. To date, there have been no perioperative complications. Incontinence and climacturia were qualitatively assessed during their initial visit and one month after the surgery. All patients reported complete resolution of their urinary symptoms, and are satisfied with their functional and aesthetic outcomes. Yafi et al. assessed the efficacy and safety of the addition of the mini-jupette at the time of IPP insertion, for the management of climacturia and incontinence . Men reported an improvement of their climacturia and incontinence by 93% and 86%, respectively . Autologous fascial Mini-Jupette is safe and effective for the management of post-prostatectomy climacturia and SUI. Intraoperative RLPP provides an objective tool to assess the actual urethral resistance to flow. The ideal RLPP value for male slings is still unknown, but a value of 41 cm H2O was sufficient for the complete resolution of incontinence .
Disclosures: Antares Pharma: Advisory board, speaker. Coloplast: Advisory board, consultant. Endo Pharmaceuticals: Advisory board, speaker. Viome: Research grant primary investigator
Yafi F.A., Andrianne R., Alzweri L. et al. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med. 2018 May;15(5):789-796. doi: 10.1016/j.jsxm.2018.01.015. Epub 2018 Mar 6.
Sourial M.W., Richard P.O., Morisset J. et al. Retrograde leak point pressure measurement improves outcomes of the Virtue male sling for postprostatectomy incontinence. Can Urol Assoc J 2017;11(7):E271-6. http://dx.doi.org/10.5489/cuaj.4381.