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An outcomes analysis of penile prosthesis implantation following radical cystoprostatectomy and urinary diversion: a multicentric retrospective cohort study

International Journal of Impotence Research volume 32, pages 126–132 (2020)Cite this article

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Abstract

There is limited scientific literature regarding the management outcomes for end-stage erectile dysfunction (ED) following radical cystoprostatectomy (RCP). This study aims to evaluate the surgical outcomes of penile prosthesis (PP) implantation. A retrospective analysis over 17 years (2004–2017) was performed from the clinical records of patients in four tertiary referral centres, whom previously had undergone RCP, followed by PP implantation for end-stage ED. Outcome measures include both intra and postoperative complications, operative duration, a 5-point Likert hematoma scale as well as length of hospital stay. Additionally, a matched-pair cohort analysis was performed, dividing patients in 2 groups according to the type of urinary diversion (neobladder versus ileal conduit/cutaneous ureterostomy). The median time elapsed between RCP and PP implantation was 38 months (IQR 20–56). The median follow-up was 18 months (IQR 12–156). A 3-piece inflatable PP was implanted in 43 patients (91.5%) whereas a semirigid device was implanted in the remainder. Reservoir position was extra-peritoneal (utilising a separate abdominal incision) in 24 patients (54.8%), while an ectopic high-submuscular placement was preferred in the remainder. PP infection and mechanical failure occurred in 1 (2.1%) and 3 cases (6.3%) respectively. The comparative analysis of surgical outcomes did not show any statistically significant difference between the two groups. Our evidence suggests that PP implantation in patients with refractory ED following RCP may represent a safe and effective procedure associated with a low incidence of complications. The main limitation of this study is represented by the non-randomised, retrospective nature as well as the lack of patients’ functional outcomes and the limited follow-up.

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References

  1. Witjes JA, Lebret T, Compérat EM, Cowan NC, De Santis M, Bruins HM, et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2017;71:462–75.

    Article  Google Scholar 

  2. Hernández V, Espinos EL, Dunn J, Maclennan S, Lam T, Yuan Y, et al. Oncological and functional outcomes of sexual function–preserving cystectomy compared with standard radical cystectomy in men: a systematic review. Urol Oncol Semin Orig Investig. 2017;35:539.e17–539.e29.

    Article  Google Scholar 

  3. Zippe CD, Raina R, Massanyi EZ, Agarwal A, Jones JS, Ulchaker J, et al. Sexual function after male radical cystectomy in a sexually active population. Urology. 2004;64:682–5.

    Article  Google Scholar 

  4. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57:804–14.

    Article  Google Scholar 

  5. Loh-Doyle J, Patil MB, Sawkar H, Wayne K, Boyd SD. 3-piece inflatable penile prosthesis placement following radical cystoprostatectomy and urinary diversion: technique and outcomes. J Sex Med. 2018:15;907–13.

  6. Rolle L, Falcone M, Ceruti C, Timpano M, Sedigh O, Ralph DJ, et al. A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the “sliding” technique for end-stage Peyronie’s disease with severe shortening of the penis and erectile dysfunction. BJU Int. 2016;117:814–20.

    Article  Google Scholar 

  7. Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, et al. Evidence-based management guidelines on Peyronie’s disease. J Sex Med. 2016;13:905–23.

    Article  Google Scholar 

  8. Morey AF, Cefalu CA, Hudak SJ. High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach. J Sex Med. 2013;10:603–10.

    Article  Google Scholar 

  9. De Luca V, Pescatori ES, Taher B, Zambolin T, Giambroni L, Frego E, et al. Damage to the erectile function following radical pelvic surgery: prevalence of veno-occlusive dysfunction. Eur Urol. 1996;29:36–40.

    Article  Google Scholar 

  10. Hekal IA, Mosbah A, El-Bahnasawy MS, El-Assmy A, Shaaban A. Penile haemodynamic changes in post-radical cystectomy patients. Int J Androl. 2011;34:27–32.

    Article  CAS  Google Scholar 

  11. Berookhim BM, Nelson CJ, Kunzel B, Mulhall JP, Narus JB. Prospective analysis of penile length changes after radical prostatectomy. BJU Int. 2014;113(5 B):131–6.

    Article  Google Scholar 

  12. Davila HH, Weber T, Burday D, Thurman S, Carrion R, Salup R, et al. Total or partial prostate sparing cystectomy for invasive bladder cancer: long-term implications on erectile function. BJU Int. 2007;100:1026–9.

  13. Kessler TM, Burkhard FC, Perimenis P, Danuser H, Thalmann GN, Hochreiter WW, et al. Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. J Urol. 2004;172(4 Pt 1):1323–7.

    Article  Google Scholar 

  14. Schlegel PN, Walsh PC. Neuroanatomical approach to radical cystoprostatectomy with preservation of sexual function. J Urol. 1987;138:1402–6.

    Article  CAS  Google Scholar 

  15. Hekal IA, El-Bahnasawy MS, Mosbah A, El-Assmy A, Shaaban A. Recoverability of erectile function in post–radical cystectomy patients: subjective and objective evaluations. Eur Urol. 2009;55:275–83.

    Article  Google Scholar 

  16. Novara G, Catto JWF, Wilson T, Annerstedt M, Chan K, Murphy DG, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015;67:376–401.

    Article  Google Scholar 

  17. Yuh B, Wilson T, Bochner B, Chan K, Palou J, Stenzl A, et al. Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Eur Urol. 2015;67:402–22.

    Article  Google Scholar 

  18. Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, et al. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67:1042–50.

    Article  Google Scholar 

  19. Menard J, Tremeaux JC, Faix A, Pierrevelcin J, Staerman F. Erectile function and sexual satisfaction before and after penile prosthesis implantation in radical prostatectomy patients: a comparison with patients with vasculogenic erectile dysfunction. J Sex Med. 2011;8:3479–86.

    Article  Google Scholar 

  20. Osterberg EC, Maganty A, Ramasamy R, Eid JF. Pharmacologically induced erect penile length and stretched penile lengh are both good predictors of post-inflatable prosthesis penile length. Int J Impot Res. 2014;26:128–31.

    Article  CAS  Google Scholar 

  21. Karpman E, Sadeghi-Nejad H, Henry G, Khera M, Morey AF. Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the sexual medicine society of North America. J Sex Med. 2013;10:2115–20.

    Article  Google Scholar 

  22. Stember DS, Garber BB, Perito PE. Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of retzius. J Sex Med. 2014;11:605–12.

    Article  Google Scholar 

  23. Gross MS, Stember DS, Garber BB, Perito PE. A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement. Int J Impot Res. 2017;29:215–8.

    Article  CAS  Google Scholar 

  24. Dadhich P, Hockenberry M, Kirby EW, Lipshultz L. Penile prosthesis in the management of erectile dysfunction following cancer therapy. Transl Androl Urol. 2017;6(Supplement 5):S883–889.

    Article  Google Scholar 

  25. Tran CN, Boncher N, Montague DK, Angermeier KW. Erosion of inflatable penile prosthesis reservoir into neobladder. J Sex Med. 2013;10:2343–6.

    Article  Google Scholar 

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Acknowledgements

We would like to express a great appreciation to all physicians involved in this study for the interest and efforts in data collection.

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Authors and Affiliations

  1. Urology Clinic – “Città della Salute e della Scienza” – Molinette Hospital, University of Turin, Turin, Italy

    Marco Falcone, Carlo Ceruti, Massimiliano Timpano, Omid Sedigh, Mirko Preto, Luigi Rolle & Paolo Gontero

  2. Urology department, Cardarelli Hospital, Napoli, Italy

    Luigi Pucci, Francesco Chiancone & Maurizio Carrino

  3. Urology department, University College of London Hospital, London, UK

    Giulio Garaffa & Gideon Blecher

  4. Urology department, Careggi Hospital, University of Florence, Florence, Italy

    Andrea Cocci

  5. Urology department, Parini Hospital, Aosta, Italy

    Arianna Gillo

  6. Urology department, Federico II Hospital, University of Naples, Naples, Italy

    Marco Capece

Authors
  1. Marco Falcone
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  2. Luigi Pucci
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  3. Giulio Garaffa
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  4. Andrea Cocci
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  5. Arianna Gillo
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  6. Marco Capece
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  7. Carlo Ceruti
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  8. Massimiliano Timpano
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  9. Omid Sedigh
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  10. Mirko Preto
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  11. Gideon Blecher
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  12. Francesco Chiancone
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  13. Maurizio Carrino
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  14. Luigi Rolle
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  15. Paolo Gontero
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Correspondence to Mirko Preto.

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Falcone, M., Pucci, L., Garaffa, G. et al. An outcomes analysis of penile prosthesis implantation following radical cystoprostatectomy and urinary diversion: a multicentric retrospective cohort study. Int J Impot Res 32, 126–132 (2020). https://doi.org/10.1038/s41443-019-0171-6

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