A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation

Abstract

PurposeThere are many grey areas in the field of penile rehabilitation after radical prostatectomy (RP). The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment. We present the first case series of patients treated by laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction.Materials and MethodsFrom June 2013 to June 2014, 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 6 months thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life.ResultsTen patients (mean age of 61 years; completed the study follow-up period (median, 32.2 months). No difference was found between the time of surgery and the 2-year follow-up evaluation in terms of penile length. The pre-surgery 36-Item Short Form Health Survey (SF-36) median score was 97. Patients were satisfied with their penile implants, and couples' level of sexual satisfaction was rated median 8. The median postoperative SF-36 score was 99 at 3 months follow-up.ConclusionsLaparoscopic extraperitoneal RP surgery with simultaneous PPI placement seems to be an interesting possibility to propose to motivated patients for preserving the length of the penis and improving their satisfaction.

Initial experience of a single center with the use of ZSI 475 penile prosthesis

“…This is the lowest value obtained and maybe it could be influenced by the high number of complications that required a surgical correction (four prosthesis replacement due to mechanical failure and one prosthesis explantation due to postoperative infection). In all cases of mechanical failure, the patients accepted or requested to undergo a replacement surgery, confirming the acceptable tolerance for surgery, and mainly, a high compliance with the patient's expectations despite the failure of the first device [ 18 , 22 , 23 ].…”

Letter to the editor: Changes in health-related quality of life after radical prostatectomy for prostate cancer: A longitudinal cohort study in Korea

“…Penile prosthesis implantation is considered third-line treatment in males with erectile dysfunction in whom medical treatment is ineffective or unacceptable. In such cases, the implantation of a prosthesis is the only possible treatment to recover the patient's penile erection and to restore the patient's sexual quality of life [45]…”

Penile Rehabilitation: the “Up”-date

“…Furthermore, men with poor/absent erectile function prior to surgery may benefit from early penile prosthesis placement rather than using PDE-5 inhibitors, ICI or VED. Mondaini et al published a case series of ten men who underwent combined radical prostatectomy and penile prosthesis placement, with the hypothesis that early placement of the prosthesis might preserve penile length [18]. Indeed, penile length was maintained (although all the men had refractory ED and may have already experienced penile shortening prior to surgery).…”