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Dual Prosthetic Implantation After Radical Cystoprostatectomy and Neobladder: Outcomes of the Inflatable Penile Prosthesis and Artificial Urinary Sphincter in Bladder Cancer Survivors.

Research paper by Jeffrey C JC Loh-Doyle, Akbar A Ashrafi, Azadeh A Nazemi, Saum S Ghodoussipour, Eli E Thompson, Kevin K Wayne, Stuart D SD Boyd

Indexed on: 22 Jan '19Published on: 22 Jan '19Published in: Urology®



Abstract

To determine the impact of radical cystectomy and orthotopic neobladder (NB) diversion on device-related outcomes in patients who undergo subsequent placement of both an artificial urinary sphincter (AUS) and 3-piece inflatable penile prosthesis (IPP). Using an institutional prosthetic database, we identified 39 patients who underwent radical cystectomy and NB and subsequent implantation of both prosthetic devices from 2003 to 2017. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection, mechanical failure, revision surgery, and functional outcomes were examined and compared to an appropriate matched group of patients (n=48, non-neobladder group). No intraoperative complications were observed. After median follow-up of 94 months (12 - 177 months), one patient developed an infection of their penile prosthesis and 4 patients developed an erosion of their artificial urinary sphincter. In each case, the infection did not involve the other device. Two patients required revision surgery of their penile prosthesis due to mechanical failure (reservoir leak, n =1; cylinder aneurysm, n = 1). Twenty one patients underwent elective revision surgery to improve continence (cuff downsizing, n = 18; pressure-regulating balloon exchange, n = 3). There were 6 cases of artificial urinary sphincter mechanical failure. No reservoir-related complications such as herniation or erosion were observed. Compared to the control group of non-neobladder patients, there were no significant differences in prosthetic infection, mechanical failure, and revision surgery. The artificial urinary sphincter and 3-piece inflatable penile prosthesis can coexist safely in patients with NB without an increased risk of device-related complications. Copyright © 2019. Published by Elsevier Inc.