Login to Access Video or Poster Abstract: MP25-08
Sources of Funding: None

Introduction

After radical cystoprostatectomy (RC), post-operative erectile dysfunction can have a significant impact on a patient's quality-of-life. Inflatable penile prosthesis (IPP) offers patients a definitive treatment option when refractory to medical therapies. To date, there is no series describing the outcomes of three-piece IPP in patients with urinary diversions. Due to the obliteration of the space of Retzius and hostile anatomy of these patients a careful surgical approach is necessary for successful outcomes. We present a description of our technique in placing a three-piece IPP for post-operative erectile dysfunction in patients with a history of RC with orthotopic neobladder (NB), ileal conduit, or continent cutaneous diversion (CCD)._x000D_

Methods

From 2007 - 2016, using an IRB-approved database we completed a retrospective review of patients who underwent primary placement of an IPP. We identified 61 patients (54 NB, 4 ileal conduit, 3 CCD) with urinary diversion who underwent subsequent placement of a three-piece IPP (AMS 700CXM, American Medical Systems Inc, Minnetonka, MN, USA). All 61 patients underwent RC in their treatment of carcinoma (55 bladder, 6 prostate). The device was implanted via an infrapubic approach and the reservoir placed in the lateral retroperitoneal space via a separate incision two finger-breadths medial to the anterior superior iliac spine. Patient demographics and postoperative outcomes including prosthetic infection were examined and statistical analysis was performed. _x000D_

Results

There were no high-grade intraoperative complications. Median follow-up was 16.8 months (2-76 months). Three patients (4.9%) developed an infection of their prosthesis that required explantation. Two of those patients underwent successful IPP reimplantation. 5 patients (8.1%) required revision surgery (4 pump relocations, 1 corporal aneurysm repair). We did not find statistically significant associations between infection and comorbidities, age, exposure to chemotherapy, or type of urinary diversion.

Conclusions

Despite advances in neurovascular sparing techniques, sexual dissatisfaction is common in patients after RC. Patients are often refractory to medical therapy. The IPP offers patients a definitive treatment option and excellent patient and partner satisfaction. In the hands of experienced surgeons, the three-piece IPP can be placed successfully in patients with all form of urinary diversion.

Funding

None