An outcomes analysis of 47 penile prosthesis implantations after cistoprostatectomy for muscle-invasive bladder cancer: a multicentric study
Falcone, M1; Pucci, L2; Cocci, A3; Gillo, A4; Ceruti, C1; Timpano, M1; Sedigh, O1; Preto, M1; Turturica, D1; Chiancone, F2; Carrino, M2; Benvenuti, S4; Rolle, L1; Gontero, P1
1: Urology dpt, University of Turin, Italy; 2: Cardarelli Hospital, Naples; 3: Urology dpt, University of Florence; 4: Urology dpt, Parini Hospital, Aosta
Objectives: To report the outcomes of a multicentric series of patients underwent a penile prosthesis (PP) implantation following radical cystoprostatectomy (RCP).
Material and Methods: A multicentric database, involving 4 tertiary referral centers, was created. From December 2004 to September 2017 65 patients underwent a PP implantation for a medically refractory ED following a RCP for bladder cancer. Clinical records were retrospectively reviewed. 47 patients, presenting comprehensive intraoperative and postoperative information were enrolled in the study. Patients were confined in 2 groups according to the type of urinary diversion: neobladder (A) or other diversions (B), including ileal conduit and ureterocutaneostomy. The intraoperative complications, the hospital stay, a postoperative haematoma scale and the postoperative complications were selected as variables for the surgical outcomes.
Results: Patients’ features are summarized in table 1. 14 patients (29.8%) were enrolled in group A, whereas the remainders were in group B. A consistent percentage (65.9%) of patients were referred to an early postoperative sexual counseling, with a median time of 12 months after surgery. Most of the patients (65.9%) started pde-5 inhibitors as a first line treatment and less than half of the them (44.7%) used a second line attempt, intracavernous injections (ICI). Surgical outcomes are listed in table 2. Overall, the time elapsed between the RCP and the PP implant was long, with a median of 38 months. Nevertheless, the median implant length resulted to be satisfactory (19 cm) and the need of a reduced diameter cylinder (CXRâ) was a rare event. Despite the previous pelvic surgery, most of the PP implanted were three-pieces. The spherical reservoir was the most used, compared to the low-profile (Concealâ). In most of the cases a safe placement of the reservoir in the extraperitoneal space through a second abdominal incision was the preferred surgeon’s choice. However, the ectopic high-submuscolar placement was used in up to 30% of cases in group A. Both intraoperative and postoperative complications resulted to be rare events. Finally, the multivariate statistical analysis did not show any independent predictive risk factor for postoperative complications.
Conclusions: PP implantation after RCP seems not to represent a concern for expert implanters, being the incidence of complications extremely low. Despite the consistent elapsed time between the RCP and the PP implantation, a satisfactory penile girth and length can be obtained in most of the cases.
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