Outcomes of simultaneous placement of an inflatable penile prosthesis and a male urethral sling through a single perineal incision

Introduction.: Synchronous implantation of an inflatable penile prosthesis (IPP) and a bulbourethral sling single via a single perineal is a unique approach in managing erectile dysfunction and stress urinary incontinence. Aim.: This article describes our surgical approach and reviews the operative time, length of hospital stay (LOS), estimated blood loss (EBL), and cost of synchronous dual prosthetic implantation compared with the implants performed individually. Additionally, we review the short-term outcomes in patients with dual sling and penile prosthesis synchronous implants. Methods.: Fifty-eight patients with IPP, 53 slings, and eight simultaneous dual implantations between January 2000 and July 2008 were retrospectively reviewed. Operative times, EBL, length of stay, cost, and complications were compared in three groups (group 1, IPP; group 2, slings; group 3, dual implants). Additionally, we reviewed pre- and postoperative Sexual Health Inventory for Men (SHIM) scores and pad use in group 3. Main Outcome Measures.: Review of operative times, EBL, LOS, cost, and complications. Results.: Dual implantation had similar operative times compared with the total time for the individual procedures (98 ± 24 minutes for IPP; 86 ± 24 minutes for sling; 177 ± 17 minutes for dual implant, P > 0.05). EBL was reduced (57 ± 30 mL for IPP; 48 ± 59 mL for sling; 49 ± 5 mL for group 3). LOS was also reduced (1.2 ± 0.45 days for IPP, 0.7 ± 0.48 days for sling; and 1.1 ± 0.50 days for dual implant). Dual implantation was associated with approximately $9,000 in savings. With a mean follow-up of 13.6 months, group 3 reported SHIM increase from 1.3 ± 0.5 to 23.5 ± 0.6 and a decrease in pad use from three pads per day (range 2-6) down to a mean of one pad per day (range 0-2). One sling erosion and one sling infection occurred in group 2. One patient in group 3 had acute urinary retention resolved with 5 days of catheter drainage. Conclusion.: Dual penile prosthesis and bulbourethral sling implantation through a single perineal incision is safe, efficient, and cost-effective.