Surgical treatment options and outcomes for concomitant treatment of post-prostatectomy erectile dysfunction and male stress urinary incontinence: a systematic review of the literature.

Simultaneous stress urinary incontinence (SUI) and erectile dysfunction (ED) are commonly caused by prostate surgery. Penile prosthesis is the gold standard for erectile dysfunction refractory to conservative therapies, fixed male sling and artificial urinary sphincter are recommended in mild and moderate/severe stress urinary incontinence respectively. The implantation of these devices can be simultaneous or delayed. This systematic review analyzes articles on simultaneous implantation of penile prosthesis and anti-incontinence devices. We search on Pubmed/Medline and Scopus: "penile prosthesis" AND "artificial urinary sphincter", "male sling", "Mini-Juppette", "ATOMS", "ProACT", "urethral bulking", "Advance", "Virtue". We have included 21 studies, mostly retrospective. The size of study cohorts is relatively small (2-65 patients) and the main cause of stress urinary incontinence and erectile dysfunction was radical prostatectomy. The average operating time appeared longer (57-218 min), although without evidence of intraoperative complications and an average hospital stay of 1-3 days. The average follow up of the studies ranged from 1 month to 94 months. Studies expressed different outcomes measurements, that could not allow a cumulative analysis. The overall continence outcomes were encouraging, with social continence rates (no more than 1 pad/day) ranging from 72 to 100%. The overall satisfaction for the inflatable penile prosthesis was high (84-100%). The postoperative complication rate did not show an augmented risk for double implants. All studies did not report any technical or surgical implant obstacles in synchronous versus metachronous implantation.