Department of Urology, University of Lisbon School of Medicine
Introduction: Erectile dysfunction (ED) and stress urinary incontinence (SUI) are known complications of the surgical treatment of prostate cancer, with a great impact on patients' quality of life and, depending on the severity, their treatment requires surgical resolution. If, on the one hand, the combined surgical repair of ED and La Peyronie's Disease (PD) is well established, on the other hand, simultaneous correction of SUI is less frequent.
The aim of this video is to present a clinical case and technical surgical description of a patient with severe ED, PD and SUI, who underwent placement of an inflatable penile prosthesis (IPP), corporoplasty with collagen fleece graft and placement of a male urethral sling.
Methods: We present a 59-year-old man, diabetic, without previous complaints of ED, diagnosed with prostate cancer, who underwent radical retropubic prostatectomy in 2017. In the postoperative period, he started tadalafil 5mg / day for 6 months, without success, presenting severe, refractory ED to pharmacotherapy and also moderate SUI, using 3-4 pads / day. He also presented complaints of preexisting dorsal penile curvature.
Penile dynamic ultrasound was performed showing a dorsal, proximal, 2 cm calcified plaque, with a dorsal curvature of 70º and a penile shaft of 10 cm long. He presented no vascular changes, but full rigidity was not achieved.
He performed urethrocystoscopy, showing a permeable urethra with good coaptation with perineal compression.
He performed a urodynamic study revealing stress urinary incontinence.
After pelvic floor muscle training, SUI improved to a mild degree, requiring only 1 pad / day.
A Coloplast Titan® OTR IPP was placed via penoscrotal incision. Then, modeling was performed, presenting a residual curvature of 45º. Subsequently, he underwent corporoplasty with a TachoSil® graft. Finally, a Virtue® male urethral sling was placed through a perineal incision.
Results: The surgery was uneventful, lasted 236 minutes with only residual blood loss. The patient was discharged after 48 hours.
At 6 weeks postoperatively, activation of the IPP was performed, and the patient presented a straight penis, without curvature and 12 cm in length. Also, he was dry, without urinary losses and without the need for a pad.
Conclusions: Combined surgical treatment of ED, PD and SUI allows the resolution of a complex pathology, in a single surgical attempt, associated with similar safety and efficacy but being more effective in terms of cost and time, when compared with a staged approach.