Can a Penile Implant and an Artificial Urinary Sphincter Be Placed at the Same Time?

Yes. Some men have both urinary incontinence and erectile dysfunction after prostate treatment, and according to the AUA/GURS/SUFU guideline on incontinence after prostate treatment, clinicians may offer these patients either a concomitant procedure, in which the penile implant and the artificial urinary sphincter are placed in the same operation, or a staged procedure, in which they are placed in separate operations. This is a conditional recommendation based on Grade C evidence.¹ The guideline states that in patients with both conditions, concomitant surgery to treat both should be considered.²

Although early investigations raised concern about infection with concomitant surgery, various studies have shown it to be safe, and it may provide significant benefits.³ In one report of 55 patients who had combined penile prosthesis and artificial urinary sphincter procedures, the combined operations took significantly longer, but the rate of device infection, erosion or malfunction was not higher than with staged procedures.⁴ Another study described similar continence, sexual function and overall satisfaction in patients who had staged or combined procedures.⁵

However, a more recent study using a New York State database found that men who had a penile prosthesis and an artificial urinary sphincter placed together had a higher rate of reoperation than men who had a penile prosthesis alone.⁶ For this reason, the guideline advises that men considering surgery for both erectile dysfunction and stress urinary incontinence should be counselled about the possible increased risk of complications.⁷

The artificial urinary sphincter itself is a well-established option: the guideline strongly recommends that clinicians discuss it with men who have mild to severe stress urinary incontinence after prostate treatment,⁸ and describes it as the most predictable and reliable treatment for this condition.⁹

Because the device is operated by squeezing a pump in the scrotum, clinicians should make sure that the patient has adequate physical and cognitive abilities to use it before implantation.¹⁰ Men should also be counselled that an artificial urinary sphincter will likely lose effectiveness over time and that reoperations are common.¹¹ The guideline cites a study in which a history of inflatable penile prosthesis placement, together with prior radiation therapy, previous cuff erosion and prior urethroplasty, was significantly associated with sphincter cuff erosion.¹²

For men who also leak urine during sexual activity, the guideline notes that the artificial urinary sphincter is associated with high rates of improvement in this symptom as well.¹³

Whether both devices are placed in one operation or in two depends on the individual patient and should be decided by the patient and his surgeon together after this counselling.