USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Tricounty Urology Associates, Washington, PA, USA.
J Sex Med. 2018 Jun;15(6):907-913. doi: 10.1016/j.jsxm.2018.01.014. Epub 2018 Feb 13.
After radical cystoprostatectomy (RC), postoperative erectile dysfunction (ED) is a common consequence with multiple contributing etiologies. The inflatable penile prosthesis (IPP) offers patients a definitive treatment option when ED is refractory to medical therapies. Because of the hostile postoperative anatomy of these patients, a careful surgical approach is necessary for successful outcomes and to avoid adjacent organ injury. To date, there is no series describing the outcomes of 3-piece IPP placement in patients with urinary diversions.
To present contemporary outcomes and a description of our technique in placing a 3-piece IPP for postoperative ED in patients with a history of RC with orthotopic neobladder, ileal conduit, or continent cutaneous diversion.
We retrospectively reviewed 80 patients who underwent primary placement of a 3-piece IPP (AMS 700; American Medical Systems Inc, Minnetonka, MN, USA) after RC and urinary diversion from 2003 through 2016. 79 patients underwent RC in their treatment of urologic malignancy (71 for bladder cancer, 8 for prostate cancer) and 1 underwent RC for refractory interstitial cystitis. An infrapubic approach was used in most patients, with reservoir placement in the lateral retroperitoneal space through a counterincision medial to the anterior superior iliac spine. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed.
Rates of device infection, revision surgery, and reservoir complications.
After mean follow-up of 53.9 months (6.5-150.7 months), 4 patients developed infection of the prosthesis that required explantation. 3 of those patients underwent successful IPP reimplantation. 5 patients required revision surgery (pump replacement, n = 3; pump relocation, n = 1; cylinder replacement for cylinder aneurysm, n = 1) for mechanical failure. No statistically significant associations were found between infection and comorbidities, urinary diversion, exposure to chemotherapy, radiation, or presence of an artificial urinary sphincter.
The 3-piece IPP is an effective treatment option for medication-refractory ED that can be placed safely in patients with all forms of urinary diversion.
This study represents the 1st series that describes a successful technique and long-term outcomes of patients with urinary diversion. It is limited by its single-surgeon, single-center experience and lacks validated patient satisfaction data in follow-up.
The 3-piece IPP, with reservoir placement in the lateral retroperitoneum, can be implanted successfully in patients with all forms of urinary diversion without a significant increase in infectious complications, reservoir erosion, or mechanical failure. Loh-Doyle J, Patil MB, Sawkar H, et al. 3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Outcomes. J Sex Med 2018;15:907-913.
根治性膀胱前列腺切除术（RC）后，术后勃起功能障碍（ED）是一种常见的后果，有多种病因。当 ED 对药物治疗无反应时，可充气阴茎假体（IPP）为患者提供了一种明确的治疗选择。由于这些患者术后解剖结构恶劣，需要谨慎的手术方法才能获得成功的结果，并避免邻近器官损伤。迄今为止，尚无关于在接受 RC 后有尿流改道术史的患者中放置 3 件式 IPP 的结果的系列描述。
介绍我们在 RC 后有原位新膀胱、回肠导管或经皮可控尿流改道术史的患者中，使用 3 件式 IPP 治疗术后 ED 的当代结果和技术描述。
我们回顾性分析了 2003 年至 2016 年间接受 AMS 700（美国医疗系统公司，明尼苏达州明尼阿波利斯市）3 件式 IPP 初次植入的 80 例患者的资料，这些患者均因 RC 和尿流改道而接受治疗。79 例患者因泌尿系统恶性肿瘤（膀胱癌 71 例，前列腺癌 8 例）而接受 RC，1 例因难治性间质性膀胱炎而接受 RC。大多数患者采用耻骨下入路，通过髂前上棘前侧的反切口将储尿器置于侧腹膜后。检查围手术期数据和术后结果，包括假体感染和机械故障，并进行统计学分析。
平均随访 53.9 个月（6.5-150.7 个月）后，4 例患者发生假体感染，需要取出。其中 3 例患者成功接受了 IPP 再植入。5 例患者需要进行翻修手术（泵置换 3 例，泵移位 1 例，因圆柱动脉瘤更换圆柱 1 例）以解决机械故障。感染与合并症、尿流改道、化疗、放疗暴露或人工尿道括约肌的存在之间无统计学显著关联。
3 件式 IPP 是治疗药物难治性 ED 的有效方法，可安全地应用于各种形式的尿流改道患者。
本研究是首例描述有尿流改道术史的患者成功技术和长期结果的系列研究。其受到单外科医生、单中心经验的限制，缺乏随访时经证实的患者满意度数据。
3 件式 IPP，将储尿器置于侧腹膜后，可以成功植入各种形式的尿流改道患者，不会显著增加感染并发症、储尿器侵蚀或机械故障。
