Inflatable penile prosthesis implantation and “Mini-Jupette” sling after radical prostatectomy for erectile dysfunction, climacturia and/or mild incontinence

All the tips and tricks are described in detail and the clearly drawn illustrations should aid the implanter (Figures 1,2).

Figure 1 After dissection, the proximal corpora cavernosa and bulbar urethra should be clean. The scrotal septum is separated from the urethral attachment. The external border of the cavernotomies are suspended. The corporotomies, of a length of 3 cm minimum, are close to the insertion of the cavernous bodies on the ischio-pubic bone. The ‘‘Mini-Jupette’’ is fixed by two running sutures to the inner borders of the two cavernotomies.

Figure 2 The cylinder tubing of the inflatable prosthesis exits the corpora cavernosa distally towards the scrotum at the posterior angle of the cavernotomy at the deep insertion of the ‘‘Mini-Jupette’’.

In this video (Video 1) we demonstrate our personal standard surgical technique of inflatable penile prosthesis implantation plus concomitant insertion of a polypropylene sling, named the “Mini-Jupette”. This innovation aims to cure severe and medical resistant erectile dysfunction and neutralize mild incontinence and climacturia, in a 53-year-old patient, 2 years after radical prostatectomy.

We highlight the uncommon anatomical landmarks of the penoscrotal plane of the bulbo-urethral and proximal cavernous bodies area where the graft will be inserted. All the tips and tricks are described in detail and the clearly drawn illustrations should aid the implanter. According to our personal experience and an American-European study that are referenced (2,3), the effectiveness of the procedure allows some prostate cancer survivors with functional morbidity after radical prostatectomy to regain a fulfilling sex life.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the Guest Editors (Martin Gross, Jay Simhan and Faysal A. Yafi) for the series “Penile Prosthesis Surgery” published in Journal of Visualized Surgery. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jovs.amegroups.com/article/view/10.21037/jovs.2020.01.01/coif). The series “Penile Prosthesis Surgery” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images. All procedures performed in this study were in accordance with the Helsinki Declaration (as revised in 2013).

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Andrianne R, Sempels M. Penile prosthesis surgery. Asvide 2020;7:066. Available online: http://www.asvide.com/watch/33118
2. Yafi FA, Andrianne R, Alzweri L, et al. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018;15:789-96. [Crossref] [PubMed]
3. Andrianne R. The "Mini-Jupette" sling at the time of inflatable penile prosthesis implantation: Adequate treatment for erectile dysfunction with mild incontinence and/or climacturia after radical prostatectomy. Prog Urol 2019;29:456-63. [Crossref] [PubMed]