Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence
Faysal A. Yafi, MD, FRCSC; Robert Andrianne, MD; Laith Alzweri, MD; Jeffrey Brady, MD; Michael Butcher, MD; Daniel Chevalier, MD; Kenneth J. DeLay, MD; Antoine Faix, MD; Georgios Hatzichristodoulou, MD; Wayne J.G. Hellstrom, MD; Lawrence Jenkins, MD; Tobias S. Kohler, MD; Daniar Osmonov, MD; Sun Hung Park, MD; M. David Schwabb, MD; Robert Valenzuela, MD; Koenraad van Renterghem, MD; Steven K. Wilson, MD
FIRST PUBLISHED: March 6, 2018 – The Journal of Sexual Medicine
Erectile dysfunction (ED) and urinary incontinence are two of the most common consequences of radical prostatectomy (RP). When both occur, an inflatable penile prosthesis (IPP) and urinary continence device (such as an artificial urinary sphincter or sling) may be implanted together.
Climacturia is another RP side effect. Some management options, such as voiding before sex, using condoms, wearing constricting loops, and medications are not always effective.
In 2005, Robert Adrianne devised a surgical approach that addresses climacturia, which can be done as an adjunctive procedure to IPP placement. This prospective multicenter, multinational, investigational, pilot study reports on the results of this strategy.
The procedure was conducted on men with ED with concomitant climacturia and/or mild stress urinary incontinence after prostate surgery. Men had “minimal” stress urinary incontinence if they used no more than 2 pads per day.
The surgical method is described as follows:
- A penoscrotal or sub-coronal incision is performed.
- After exposure of the urethra and the 2 corpora, proximal bilateral symmetrical corporotomies at least 2 cm in length are made and their lengths are recorded.
- Stay sutures are placed at the discretion of the surgeon.
- The distance between the medial aspects of the corporotomies is measured.
- A mini-jupette graft is fashioned according to these measurements: length is defined as the size of the corporotomy and width is defined as the medial inter-corporal distance. Surgeons can select the graft material of their choice to create the sling.
- The graft is sewn into place with running non-absorbable sutures to the medial corporotomies.
- A clamp is placed under the sling to avoid over-tensioning. If tension is noted, then the sling is revised and a wider sling is used.
- Once the sling is in place, the IPP reservoir and bilateral cylinders are placed in the usual manner.
If desired, the graft may be tested by inflating the cylinders or by performing a cystoscopy.
Note: A video demonstration of this procedure is available at the Video Journal of Prosthetic Urology here.
Postoperative management is similar to that after IPP placement. Patients are taught to use the device and may resume intercourse after 6 weeks, with 3- and 6-month follow ups.
In this study, 38 men with a mean age of 65.3 underwent the mini-jupette procedure between January 2016 and July 2017 at 17 locations in the United States, France, Belgium, Germany, and Korea. Thirty-six men had RP as treatment for prostate cancer; the remaining 2 men had transurethral resection of the prostate for treatment of benign prostate disease. After surgery, 30 men had climacturia and 32 had incontinence. None of the men experienced intraoperative complications.
- Assessed with IIEF-5.
- Average scores improved from 7.9 points before surgery to 24.6 at a mean follow-up period of 5.1 months.
- 89% of the men (n=28) saw improvements in their incontinence.
- 75% of men achieved complete resolution (needing no pads).
- Overall, the average number of daily pads decreased from 1.6 preoperatively to 0.3 postoperatively.
- 78.6% of men (n=28) experienced improvement in climacturia.
- Almost 68% had complete resolution of climacturia.
- 92.8% reported subjective improvement.
- 13% of men (n=5) developed complications: one with significant postoperative pain and four requiring device explantation.
- One patient developed urinary retention, urethral erosion, and device infection. He eventually developed an uncontrolled pulmonary embolism and expired.
The Adrianne mini-jupette procedure is an “easy and feasible procedure that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence undergoing IPP placement.” However, further studies with more patients and longer follow-up periods are needed to confirm safety and benefits.
The optimum graft to be used of the mini-jupette sling has not yet been determined, but a synthetic material is suggested as most appropriate.