title: Combined inflatable penile prosthesis-artificial urinary sphincter implantation: no increased risk of adverse events compared to single or staged device implantation.
abstract: OBJECTIVE
  Little data exist on the outcome of combined inflatable penile prosthesis and artificial urinary sphincter insertion for erectile dysfunction and stress urinary incontinence. We assessed patient outcomes for combined vs single device implantation at a single institution.
  
  
  METHODS
  We retrospectively reviewed the records of all patients who underwent inflatable penile prosthesis and artificial urinary sphincter insertion at our hospital from January 2000 to December 2011. A total of 55 combined procedures were performed compared to the single insertion of 336 inflatable penile prostheses and 279 artificial urinary sphincters.
  
  
  RESULTS
  The surgical approach consisted of penoscrotal incisions for inflatable penile prostheses and transperineal incisions for artificial urinary sphincter cuff placement with a secondary lower abdominal incision for reservoir placement. Men treated with combined implantation had greater mean age and were at greater risk for prostate cancer diagnosis and treatment, and at lesser risk for Peyronie disease than men who received an inflatable penile prosthesis alone (each p<0.05). Although operative time was significantly longer for the combined procedure than for the inflatable penile prosthesis alone and the AUS alone (mean 218.1 vs 145.9 and 114.7 minutes, respectively, p<0.0001), the rate of device infection, erosion or malfunction was not increased irrespective of combined or staged procedures (p>0.05).
  
  
  CONCLUSIONS
  Combined inflatable penile prosthesis-artificial urinary sphincter implantation and staged prosthesis implantation are feasible without an increased risk of adverse outcomes compared to implantation of a single prosthesis. Patients with concomitant erectile dysfunction and stress urinary incontinence should be counseled about the possible advantages of this surgical option, which include a single anesthesia event and faster resumption of sexual activity and urinary control.
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland. Electronic address: rsegal3@jhmi.edu.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Segal
authors.forename: Mercelo R
authors.initials: MR
authors.lastname: Cabrini
authors.forename: Elaine D
authors.initials: ED
authors.lastname: Harris
authors.forename: Jacek L
authors.initials: JL
authors.lastname: Mostwin
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
mesh_terms: D000368:Aged; D007172:Erectile Dysfunction / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation / Q000379:methods; D015917:Penile Prosthesis / Q000009:adverse effects; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D016741:Urinary Sphincter, Artificial / Q000009:adverse effects
keywords: AUS; CCI; Charlson comorbidity index; ED; IPP; SUI; artificial urinary sphincter; erectile dysfunction; inflatable penile prosthesis; penis; prostheses and implants; stress; stress urinary incontinence; urinary incontinence