Concurrent urinary incontinence (UI) and erectile dysfunction (ED) can greatly damage a patient's quality of life. Owing to the intertwined anatomy, treatment options for one most certainly have implications on the other.
The aim of this review is to characterize and elucidate the treatment patients with postprostatectomy UI undergoing concurrent or subsequent treatment of ED. These principles can be extrapolated to all patients with UI and ED.
The literature on postprostatectomy UI treatment in the context of concurrent ED was reviewed through a Medline search. Original research using quantitative and qualitative methodologies was considered.
The epidemiology, workup, and management of postprostatectomy UI being mindful of ongoing or future ED treatments are the main outcome measures. Owing to the intertwined anatomy, treatment options for UI and ED have implications on the other. It is essential for the surgeon to obtain an understanding of the patient's degree of bother for each process, personal preference on treatment options, and management of expectations. Surgical treatment options include a combination of the artificial urinary sphincter, sling, inflatable penile prosthesis, semi-rigid penile prosthesis, and new techniques such as the Mini-Jupette. The appropriate combinations will be determined by patient factors of dexterity, preference, degree of leakage, history of radiation, and so on. The decision of staged vs dual implant will be largely driven by the surgeons' preference, payor limitations, and comfort level. This issue is particularly challenging in redo cases where we advocate for cuff downsizing or tandem cuff before the transcorporal approach is used with the goal of preserving sexual function.
The concurrent treatment of ED and UI requires thoughtful workup, meticulous attention to detail, and an armamentarium of surgical skills. It is crucial for the surgeon to understand and manage patient expectations in treating these delicate and difficult pathologies. Ajay D, Mendez MH, Wang R, et al. Treatment of Urinary Incontinence in Patients With Erectile Dysfunction. J Sex Med 2020;XX:XXX-XXX.
Sexual medicine reviews. 2020 Jul 01 [Epub ahead of print]
Divya Ajay, Melissa H Mendez, Run Wang, O Lenaine Westney
Urinary Tract and Pelvic Reconstruction fellow, Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA. Electronic address: ., Sexual Medicine and Genital Reconstruction fellow, Department of Urology, University of South Florida, Tampa, FL, USA., Professor, Department of Urology, University of Texas McGovern Medical School and MD Anderson Cancer Center, Houston, TX, USA., Professor, Department of Urology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.