Hydraulic 3-Pieces Penile Prosthesis Sparing Artificial Urinary Sphincter Reimplantation

E. Veliev, A. Tomilov, G. Dmitrenko, E. Golubtsova

penile prosthesis, artificial urinary sphincter, erectile dysfunction, incontinence

Introduction:

Erectile dysfunction after radical prostatectomy is often associated with urinary incontinence. In order to improve the quality of life, a simultaneous or staged penile prosthesis (PP) and artificial urinary sphincter (AUS) implantation can be performed. Long-term AUS use often requires revision due to complications or urinary incontinence recurrence. Considering the close relationship between both implants, revision of one of them carries risks for the other.

Objectives:

Hydraulic 3-pieces penile prosthesis sparing artificial urinary sphincter reimplantation clinical case demonstration.

Methods:

We present a clinical case of patient with PP and recurrent urinary incontinence after AUS implantation. A 64-year-old male presented with complaints of urinary incontinence. In 2013 he underwent a laparoscopic radical prostatecomy for prostate adenocarcinoma. After the operation, he developed severe stress urinary incontinence and severe erectile dysfunction. In 2014, simultaneous implantation of artificial urinary sphincter AMS 800 (4 cm cuff) and three-piece hydraulic penile prosthesis AMS 700 was performed. After implantation he still used 2 to 3 pads per day. In 2014, a second 4 cm cuff was implanted, with no positive effect. In 2016 urodynamic study was performed, and detrusor overactivity was diagnosed. Antimuscarinic therapy was administrated. Patient used a safety pad, there was a significant improvement in quality of life. In 2025 he noted urinary incontinence recurrence. ICIQ-UI SF score was 21. MRI showed an empty AUS balloon. Urethroscopy confirmed no complete closure of both AUS cuffs.

Results:

After standard antimicrobial prophylaxis, surgical intervention was performed. Mobilisation of connection tubes, reservoir, proximal cuff and pump was performed. No construction defects were detected and no signs of infection were observed. The artificial urinary sphincter was replaced with careful attention to the components of the penile prosthesis. One of the cuffs was leave in place according “drain and retain” conception. There were no complications during the postoperative period. After AUS activation in 6 weeks the patient does not use pads, ICIQ-UI SF score was 0.

Conclusions:

Revision of the artificial urinary sphincter in patients with an implanted hydraulic penile prosthesis is a challenging surgery, which, however, allows restoring the function of the device and improving the patient's quality of life while penile prosthesis sparing.

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