“Andrianne mini-jupette” graft at the time of inflatable penile prosthesis placement for the management of post-prostatectomy climacturia and minimal urinary incontinence
Yafi, FA1; Andrianne, R2; Brady, J3; Butcher, M4; Chevalier, D5; Faix, A6; Hatzichristodoulou, G7; Hellstrom, WJ8; Jenkins, L9; Osmanov, D10; Park, S11; Schwalb, M12; Valenzuela, R13; van Renterghem, K14; Wilson, SK15
1: University of California Irvine, United States; 2: Centre Hospitalier Universitaire de Liège, Belgium; 3: Florida Urology Associates, USA; 4: Parc Nicollet Health Systems, Saint Louis Park, Minnesota, USA; 5: Centre Hospitalier Universitaire de Nice, France; 6: Clinique Beau soleil - Montpellier, France; 7: Julius-Maximilians-University of Würzburg, Germany; 8: Tulane University, New Orleans, USA; 9: Ohio State University, Columbus, USA; 10: University Hospital Schleswig Holstein, Campus Kiel, Germany; 11: Sewum Prosthetic Urology Clinic, Seoul, Korea; 12: Middletown Medical, Middletown, New York, USA; 13: Washington Heights Urology, New York, USA; 14: Virga Jesse Hospital, Hasselt, Belgium; 15: Institute of Urological Excellence, La Quinta, USA
Objectives: Following radical prostatectomy (RP), erectile dysfunction may ensue, often necessitating the need for inflatable penile prosthesis (IPP) insertion. Other consequences of RP include urinary incontinence and climacturia. The “mini-jupette” is a mesh that is used to approximate the medial aspects of the bilateral corporotomies at the time of IPP insertion. We hypothesize that, as the cylinders expand on inflation, this may help limit climacturia, as well as leakage in patients with minimal incontinence.
Materials and methods: We conducted a pilot multi-center study of patients with post-RP ED and climacturia and/or mild urinary incontinence (≤2pads/day) undergoing IPP insertion with concomitant placement of a “mini-jupette” graft.
Results: Thirty seven underwent the “mini-jupette” procedure. The mean age of the population was 65.6 years (SD 7.5). Twenty nine had post-RP climacturia and 31 patients had post-RP incontinence (mean 1.3 pads/day [SD 0.8]). Thirty patients received Coloplast Titan, 4 AMS 700 LGX, and 3 AMS 700 CX IPPs. Mean corporotomy size was 2.9cm (0.9). Mean graft measurements were as follows: width 3.1cm (0.7), length 3.3cm (1.3), and surface area 10.2cm2 (5.0). At a mean follow-up of 5.5 months (SD 7.3), there were 5 post-operative complications (13.5%) of which 4 were explanted. Climacturia and incontinence were subjectively improved in 93% and 89%, respectively. Mean pads/day decreased by 1.1 post-operatively.
Conclusions: The Andrianne Mini-jupette is a feasible procedure that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence. Longer follow-up and larger patient cohorts are needed to confirm the long term safety and benefits of this intervention.
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