Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence - Beyond the Abstract

Erectile dysfunction (ED) and stress urinary incontinence (SUI) are common consequences of radical prostatectomy (RP). In men with severe or medication-refractory ED, insertion of an inflatable penile prosthesis (IPP) represents an excellent and lasting therapeutic option. Concomitant climacturia, or urinary leakage with sexual intercourse, is a lesser known and often underdiagnosed condition occurring in around 20% of men following RP. To date, there have not been any consistent reports of successful interventions for the management of climacturia.

In 2005, Professor Andrianne in Belgium first described the placement of a sling termed "Mini-Jupette", French for mini-skirt, as an adjunct to IPP placement to address bothersome leakage. After the standard coroporotomies are performed, a sling is fashioned and placed over the urethra and sutured to the medial corporotomies. When the cylinders are inflated, the sling is stretched which leads to ventral tension on the urethra which helps limit urinary leakage.

To validate Andrianne's results, we conducted a prospective, multi-institutional, international study of 38 patients with concomitant ED and climacturia and/or minimal SUI who underwent IPP and Mini-Jupette placement. At a mean follow-up of 5.1 months, SUI improved in in 89% of patients with 75% describing complete resolution. Subjective improvement in climacturia was reported in 93% of patients, with 68% describing complete resolution. There were 5 post-operative complications, 3 of which required IPP explantation. These complications, however, occurred earlier in our experience and are avoidable with our revised strategies for better tensioning and suturing of the graft.

Overall, the Mini-Jupette is a feasile adjunct to IPP that can be used for subsets of patients with post-RP climacturia and/or mild SUI.

Written by: Faysal A. Yafi, M.D., F.R.C.S.C. University of California Irvine/Department of Urology, Assistant Clinical Professor/Director of Men's Health, Orange, CA

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