Laparoscopic radical prostatectomy with the simultaneous implant of a penile prosthesis: ten years follow up.

Abstract

Introduction: Even today, despite technological evolution, erectile dysfunction remains the most feared complication after radical prostatectomy surgery expecially for patients who report pre-existent refractory erectile dysfunction (ED) and patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3, who undergo non-nerve sparing radical prostatectomy (RP). To overcome this issue, Khoudary et al. performed the first simultaneous placement of a penile prosthesis during open RP in 1997, aiming at an early return to sexual function without any impact on oncological outcomes and without significant adverse effects. Ten years ago we performed laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) on ten patients in order to preserve the full length of the penis and to improve their satisfaction and quality of life (QoL) increasing the chances of ED resolution.

Objectives: Aim of this study is to illustrate the ten years follow up of this case series which has no terms of comparison in the world. Oncological and functional results were analyzed.

Materials and methods: In 2013 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis). 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 year thereafter. The main outcome measures were biochemical recurrence-free rate, penile length and quality of life.

Results: Eight patients with mean age 71 (range 66-75) were reached at the 10-year follow-up; one patient died of acute infarction 10 years after surgery and another one died of disease 7 years after surgery. Partners had, currently, mean age 60 (range 37-71). Mean preoperative PSA was 9.3 (6.3-13.7) and mean PSA at 10 years was 0.08 (range 0.01-1.2). International index erectile function IIEF before surgery was 11 (range 9-14) and 23 (range 22-25) at 10 years. Partner satisfaction rating increased from 7 (post-surgical) to 8 at 10 years. Penis length was unchanged after 10 years: mean intraoperative length was 9 cm (range 8.5-9.5) and mean length at 10 years was 8.8 cm (range 8-9.5).

Conclusions: In our cases, laparoscopic radical prostatectomy with the simultaneous implant of a penile prosthesis demonstrate to be an interesting option to offer to selected and highly motivated patients. Outcomes like preservation of the penis length, resuming of normal sexual activity 21 days after surgery, partner satisfaction and oncological safety at 10-year follow-up make it a valid surgical technique to be proposed in clinical practice if performed by an experienced team in prosthetic surgery.