Presentation Authors: Joel Hillelsohn*, New York, NY, Matthew Ziegelmann, Chicago, IL, Marissa Kent, New York, NY, Michael Ryan Farrell, Lawrence Levine, Chicago, IL, Robert Valenzuela, New York, NY
Introduction: Climacturia with or without stress urinary incontinence (SUI) is commonly encountered with erectile dysfunction (ED) after prostate cancer treatment. Previous work has suggested that placement of the Adrianne mini-jupette graft with inflatable penile prosthesis can significantly improve these bothersome symptoms. Here, we sought to describe our modified technique for placement of a â€œmini male slingâ€ (MMS) at the time of penile prosthesis (PP) placement for men with ED and climacturia with or without mild SUI and assess early postoperative outcomes from two centers.
Methods: A retrospective review was performed for patient who underwent IPP and MMS placement with Virtue sling mesh or Tutoplast human pericardium (Coloplast Corp, Minneapolis, MN) by two high-volume prosthetic surgeon between 2016-2018 using a similar technique. After proximal exposure, the MMS is sutured to the corpora at the level of the bulbar urethra, proximal to the planned corporotomies. Care is taken to avoid excessive tension on the urethra. Changes in patient-reported climacturia and pads per day (PPD) for SUI assessed pre-operatively and at each post-operative visit were compared for each patient using McNemarâ€™s test with a statistical significance threshold of p < 0.05.
Results: Thirty-four men underwent both IPP and MMS placement (30 concurrent IPP/MSS, 4 sequential IPP/MSS). Mean patient age was 68 years (SD 6.5) and mean patient BMI was 26 (SD 3.4). Etiology for ED and urinary symptoms was prostatectomy (RP) 28/34 (82%) and RP plus radiation in 6/34 (18%). Virtue mesh MMS was used in 29/34 (85%), and Tutoplast in 5/34 (15%). Preoperative urinary symptoms included climacturia-only in 10/34 (29%), SUI only in 6/34 (18%), and combined climacturia/SUI in 18/34 (53%). For those with SUI, mean preoperative PPD was 1.5 (SD 1.1; range 0.5 - 4). At a mean follow-up was 3.8 months (SD 2.8), climacturia resolved in 28/28 patients (100%). Mean postoperative pad use was 0.4 PPD (SD 0.7) and mean ppd decrease was 1.0 (SD 0.8; p < .001). Complete SUI resolution was seen in 15/24 (63%), with improvement noted in an additional 6/21 (29%). No difference in outcomes was seen based on surgeon or sling-type. Complications included penile edema in 2 patients (6%) and transient postoperative urinary retention in 1 patient (3%).
Conclusions: Our early results suggest that placement of an IPP with MMS for ED and climacturia or SUI via our modified approach significantly improves urinary symptoms. While further study is needed, this approach may be considered in the appropriately counseled patient.