Introduction: Synchronous penile prosthesis (PP) and artificial urinary sphincter (AUS) implantation for the treatment of erectile dysfunction (ED) and stress urinary incontinence allows for avoidance of a secondary surgical procedure, however the safety of this approach has been challenged by existing literature. We sought to determine whether synchronous PP and AUS implantation increases the risk of intraoperative, perioperative, or postoperative complications.
Methods: The Healthcare Cost and Utilization Project State Inpatient and Ambulatory Databases for California (2007-2011) and Florida (2009-2014) were utilized. Patients were identified as having undergone AUS, IPP or combined AUS/IPP by ICD-9 and CPT codes. Baseline patient characteristics were assessed. We compared outcomes in patients undergoing combination AUS/PP versus those undergoing PP or AUS alone. Outcomes of interest include 90-day readmissions, 90-day ER visits, surgical complications, and 90-day device complications.
Results: A total of 20,593 patients were identified who underwent PP or AUS, 245 of whom underwent combined PP and AUS. Patients undergoing prosthesis placement primarily had Medicare insurance and were Caucasian. Patients undergoing AUS placement alone were older (70.5 years), compared to IPP alone (65.7 years) or synchronous (67.2 years). Patients undergoing a synchronous procedure had higher 90-day readmission rates compared to PP or AUS alone (13.9% vs 7.2%, p<0.001). Additionally, patients undergoing a synchronous procedure had higher rates of device complications within 90 days (6.1% vs 3.4%, p=0.021). Lastly, patients undergoing a combined PP and AUS procedure were more likely to have minor/moderate complications (8.89% vs 2.35%, p<0.001). No significant difference was seen in the rate of ER visits within 90 days.
Conclusions: Synchronous PP and AUS implantation is feasible, but is associated with higher readmission rates, 90-day device complications and surgical complications. Caution should be considered in this higher risk population. Source of