title: Surgical implantation of artificial urinary device and penile prosthesis through trans-scrotal incision for postprostatectomy urinary incontinence and erectile dysfunction: synchronous or delayed procedure?
abstract: OBJECTIVE
  To compare simultaneous and 2-stage surgical implantation of an artificial urinary sphincter (AUS) and penile prosthesis (PP) for patients with severe urinary incontinence and erectile dysfunction after prostatectomy.
  
  
  METHODS
  The data from 23 patients were reviewed, 15 (group 1) underwent simultaneous implantation and 8 (group 2) underwent 2-stage surgery. The operative time, complications, postoperative pain, incidence of pre- and postoperative urinary incontinence, erectile dysfunction rating (International Consultation on Incontinence questionnaire, Incontinence Quality of Life, International Index of Erectile Function, and Erectile Dysfunction Inventory of Treatment Satisfaction), and patient satisfaction were evaluated.
  
  
  RESULTS
  The mean operative time was 140 minutes for the simultaneous procedure (group 1) and 105 minutes for AUS placement and 65 minutes for PP placement (group 2). No major postoperative complications were recorded. The average postoperative hospital stay was 2.5 days after the double-implant procedure and 2.4 days after AUS and 1.2 days after PP placement. The visual analog scale score at 6 and 24 hours after surgery was 5 and 3 in group 1, and 4 and 3 after AUS and 3 and 2 after PP (group 2; P > .05). At 1 year, all patients were socially continent, with an average International Consultation on Incontinence score of 2 in group 1 and 2 in group 2. Of the patients in groups 1 and 2, 65% and 68% were completely dry, respectively (P > .05). The Incontinence Quality of Life score increased from 37 to 84 in group 1 and from 41 to 82 in group 2. The Patient Global Impression of Improvement revealed that 92% of group 1 and 95% of group 2 experienced "great improvement" (P > .05). The International Index of Erectile Function and Erectile Dysfunction Inventory of Treatment Satisfaction score was 70 of 75 and 87 of 100 in group 1 and 72 of 75 and 86 of 100 in group 2, respectively (P > .05). Group 1 patients were completely satisfied, and all group 2 patients stated they would have preferred synchronous surgery.
  
  
  CONCLUSIONS
  AUS and PP synchronous placement is feasible and safe and as effective as the 2-stage procedure, with better acceptance by patients.
authors.affiliation: Divisione Universitaria di Urologia II, Dipartimento di Discipline Medico-Chirurgiche, Ospedale San Giovanni Battista-Molinette, Università degli Studi di Torino, Torino, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rolle
authors.forename: Carlo
authors.initials: C
authors.lastname: Ceruti
authors.forename: Omid
authors.initials: O
authors.lastname: Sedigh
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Timpano
authors.forename: Paolo
authors.initials: P
authors.lastname: Destefanis
authors.forename: Beatrice
authors.initials: B
authors.lastname: Lillaz
authors.forename: Elisa
authors.initials: E
authors.lastname: Galletto
authors.forename: Claudia
authors.initials: C
authors.lastname: De Maria
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.forename: Ettore
authors.initials: E
authors.lastname: Dalmasso
authors.forename: Dario
authors.initials: D
authors.lastname: Fontana
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D015917:Penile Prosthesis; D011468:Prostatectomy / Q000009:adverse effects*; D011469:Prostatic Diseases / Q000601:surgery; D011788:Quality of Life; D012189:Retrospective Studies; D012611:Scrotum / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial