Simultaneous placement of sling, prosthesis efficacious

Key Points

Homewood, AL-Concurrent incontinence and erectile dysfunction following radical prostatectomy is not an uncommon finding. Researchers now say the two problems can be resolved simultaneously by combining the placement of a male sling and implanatable penile prosthesis in a single procedure.

The surgery saves time and money while proving to be efficacious with low morbidity, study authors from several institutions have found.

"A single procedure to treat both problems at the same time is not unheard of," first author Brian Christine, MD, director of erectile restoration and prosthetic urology at the Urology Centers of Alabama, Homewood, told Urology Times. "In the past, the combined procedure was conducted with an artificial urinary sphincter. The development of the AdVance male sling system [American Medical Systems, Minnetonka, MN] seemed to me to open the next chapter in the treatment of concurrent incontinence and ED."

At the 2010 AUA annual meeting in San Francisco, Dr. Christine and co-authors Anthony Bella, MD, of the University of Ottawa, Ontario, and Steve Wilson, MD, of Indio, CA, presented data from the first 22 patients undergoing the combined procedure. The patients were followed at 1, 2, and 6 weeks post-op after having been instructed to inflate the prosthesis daily beginning at 2 weeks post placement. At 6 weeks, the patients were released to engage in unrestricted activity to include intercourse.

The efficacy of the treatment was assessed every 6 months with clinic visits. Additional data were acquired with questionnaires and telephone interviews. Data for the presentation were compiled at 22 months' follow-up.

At that time, 19 (86%) of the 22 patients reported being completely continent. One reported occasional use of a pad (perhaps once per week), and two patients reported daily pad use. Both of these patients were using three to five pads daily before the surgery, the researchers noted. Four patients presented with urinary retention that resolved within 10 days post-op with no secondary procedure required.

High rate of satisfaction seen

Regarding the performance of the prosthesis, Dr. Christine said that 20 (91%) of the 22 patients reported being "satisfied" or "very satisfied." Two said they were unsatisfied owing to a perceived loss of penile length. The perception of length loss is not uncommon among patients receiving implants.

"I counsel patients that the implant will not make their penis longer. During the exam, I place the penis on stretch, which gives them a realistic idea as to how long their penis will be with the implant inflated. I think it is critical that patients understand this before proceeding to surgery," Dr. Christine said.

Although there is no hard and fast rule, Dr. Christine said that he will consider surgical intervention 6 months after a prostatectomy.

"In the past, the thought was to give patients a year after a prostatectomy to assess continence and consider intervention. I think that is changing," he said. "We are becoming more aggressive and intervening earlier because we have a device that is patient friendly. The male sling has a high degree of efficacy and low morbidity.

"When a patient shows no [continence] improvement after 6 months, we can start talking about intervention. If they are showing improvement, if they were using five pads a day at 4 months and are now using two pads daily at 6 months, it makes sense to give them more time. You have to individualize these considerations."

The combined sling-prosthesis procedure is no more challenging than conducting either procedure alone, although because it is a dual procedure, it may be a little more time consuming, he said. The mean operating time was 92 minutes (range, 49 to 102 minutes). None of the patients presented with a post-surgery implant infection.

Dr. Christine and some study co-authors serve as consultant/advisers and/or meeting participant/lecturers for American Medical Systems.