Artificial Urinary Sphincter Considerations in Men with Prior Inflatable Penile Prosthesis Placement

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Despite advances in patient selection, surgical technique, and the perioperative rehabilitation of urinary continence and sexual function, functional complications related to the surgical treatment of prostate cancer persist. Urinary incontinence (UI) and erectile dysfunction (ED) are most commonly reported and are associated with significant physical, psychological, and interpersonal distress. The surgical management of severe and/or refractory UI and ED includes the artificial urinary sphincter (AUS) and inflatable penile prosthesis (IPP), respectively. These surgical procedures may be performed in a dual synchronous or staged (metachronous) manner for men who have failed conservative management, depending on individual clinical presentation and the progression of symptoms over time. In some cases, patients may require de novo AUS placement along with IPP revision. There is a clear advantage of simultaneous dual implant placement with respect to total costs and operative time. Sellers et al., noted a shortened operative time of 24.7% and total cost savings of $7,000 when combined AUS and IPP placement was performed via a single transverse scrotal incision when compared with staged placement.1 However, complication rates are reported to be higher during dual implant placement with rates of erosion being higher for AUS+IPP compared with AUS alone (11.6% vs 4.3%, P = .037).2 As well, shorter operative times are associated with a lower infection rate and therefore avoiding a prolonged procedure for combined placement would reduce the risk of exposing both components to infection. Finally, Medicare and some commercial insurance companies do not reimburse the hospital and the surgeon at the same rate for a second simultaneous implant.3

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