title: 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.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
authors.affiliation: APHP, Urology Department, Henri Mondor Teaching Hospital, Créteil, France.
authors.forename: René
authors.initials: R
authors.lastname: Yiou
authors.affiliation: APHP, Department of Anesthesiology, Henri Mondor Teaching Hospital, Créteil, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Binhas
mesh_terms: D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation; D015917:Penile Prosthesis; D010549:Personal Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology / Q000523:psychology / Q000601:surgery / Q000628:therapy*
keywords: Adjustable Continence Therapy; Erectile Dysfunction; Male Urinary Incontinence; Penile Prosthesis; Radical Prostatectomy