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Volume 17, Issue 5 (September 2015) 17, 792–796; doi: 10.4103/1008-682X.143757

Management of end-stage erectile dysfunction and stress urinary incontinence after radical prostatectomy by simultaneous dual implantation using a single trans-scrotal incision: surgical technique and outcomes

Juan I Martínez-Salamanca1, Estefanía Linares Espinós2, Ignacio Moncada3, Luis Del Portillo1, Joaquín Carballido1

1Department of Urology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid 28222, Spain.
2Hospital Universitario Infanta Sofía, Madrid 28702, Spain.
3Hospital La Zarzuela, Madrid 28023, Spain.

Correspondence: Dr. JI Martínez‑Salamanca (jims09@me.com)



Stress urinary incontinence (SUI) and end‑stage erectile dysfunction (ED) after radical prostatectomy (RP) can decrease a
patient’s quality of life (QoL). We describe a surgical technique involving scrotal incision for simultaneous dual implantation of an
artificial urinary sphincter (AUS) and an inflatable penile prosthesis (IPP). Patients with moderate to severe SUI (>3 pads per day)
and end‑stage ED following RP were selected for dual implantation. An upper transverse scrotal incision was made, followed
by bulbar urethra dissection and AUS cuff placement. Through the same incision, the corpora cavernosa was exposed, and an
IPP positioned. Followed by extraperitoneal reservoirs placement and pumps introduced in the scrotum. Short‑term, intra‑ and
post‑operative complications; continence status and erectile function; and patient satisfaction and QoL were recorded. A total of
32 patients underwent dual implantation. Early AUS‑related complications were: AUS reservoir migration and urethral erosion. One
case of distal corporal extrusion occurred. No prosthetic infection was reported. Over 96% of patients were socially the continent
(≤1 pad per day) and >95% had sufficient erections for intercourse. Limitations of the study were the small number of patients,
the lack of the control group using a perineal approach for AUS placement and only a 12 months follow‑up. IPP and AUS dual
implantation using a single scrotal incision technique is a safe and effective option in patients with SUI and ED after RP. Further
studies on larger numbers of patients are warranted.

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.