Combined Implantation of a Penile Prosthesis and Adjustable Continence Therapy ProACT in Patients with Erectile Dysfunction and Urinary Incontinence after Radical Prostatectomy: Results of a Prospective Pilot Study

INTRODUCTION - The treatment of postradical prostatectomy erectile dysfunction (post-RP-ED) and stress urinary incontinence (post-RP-SUI) may require the combined implantation of a penile prosthesis and incontinence surgery.

However, there is a lack of consensus regarding which incontinence surgery should be associated with a penile implant.

AIMS - To evaluate the combined implantation of a penile prosthesis and the adjustable continence therapy ProACT in patients with post-RP-ED and post-RP-SUI.

METHODS - We implanted the ProACT device and a penile prosthesis synchronously (n = 6) and asynchronously (n = 4) in 10 patients with moderate post-RP-SUI and severe post-RP-ED. We evaluated the effects on urinary incontinence using the ICIQ and PGI-I scores and pad use. We evaluated the effect on sexual function using the EHS and Global Assessment Questionnaire (GAQ), and we evaluated satisfaction with the penile prosthesis on a 5-point scale. Postoperative pain associated with each procedure was evaluated by a numeric rating scale.

RESULTS - No cases of urinary retention or prosthesis infection were observed. Postoperative pain was mainly related to penile prosthesis implantation. After a mean follow-up of 22. 7 ± 20. 9 months (range: 6-53), significant improvements of the ICIQ score (15. 3 ± 3. 7 vs. 4. 7 ± 2. 3, P < 0. 001) and pad use per day (2. 8 ± 1. 2 vs. 0. 3 ± 0. 5, P < 0. 001) were observed compared with baseline. According to the PGI-I questionnaire, eight patients described a very much improved (n = 6) or much improved (n = 2) urinary condition. All patients declared an EHS = 4 with the use of penile prosthesis; all patients were very satisfied (n = 6) or satisfied (n = 4) with their penile prosthesis. All patients answered the GAQ positively.

CONCLUSIONS - The combined implantation of a Pro-ACT device and penile prosthesis represents a feasible therapeutic option in patients with post-RP-SUI and post-RP-ED. The absence of postoperative pain associated with the ProACT procedure may represent the main interest in this therapy. Yiou R and Binhas M. Combined implantation of a penile prosthesis and adjustable continence therapy ProACT in patients with erectile dysfunction and urinary incontinence after radical prostatectomy: Results of a prospective pilot study. J Sex Med **;**:**-**.

The journal of sexual medicine. 2015 Nov 27 [Epub ahead of print]

René Yiou, Michèle Binhas

APHP, Urology Department, Henri Mondor Teaching Hospital, Créteil, France. , APHP, Department of Anesthesiology, Henri Mondor Teaching Hospital, Créteil, France.