Dual Implantation of Artificial Urinary Sphincter and Inflatable Penile Prostheses for Concurrent Male Urinary Incontinence and Erectile Dysfunction

Table 1

Comparison between advantage and disadvantage of synchronous and nonsynchronous dual prosthetic insertion [7–17].

Synchronous dual implantation	Sequential dual implantation
Advantages	Advantages
(i) Single incision; (ii) Faster operating time; (iii) Single anaesthetic event; (iv) Shorter hospital stay; (v) Decreased overall recovery time; (vi) Increased cost savings; (vii) Theoretical reduction in the infection risk; (viii) Supine position allowing more mobility of the bulbar urethra facilitating posterior dissection; (ix) Easier placement of the AUS pump; (x) Decrease in the risk of AUS pump migration	(i) More time allowed for a patient to accommodate the first device before considering a second implant; (ii) Theoretical decreased initial confusion to operate the device; (iii) For AUS, there appears to be a higher completely dry rate and fewer subsequent tandem cuff additions when placed at a more robust proximal bulb of the urethra during a perineal incision
Disadvantages	Disadvantages
(i) Sufficient patient dexterity needed to activate either pump as required; (ii) Theoretical concerns of patient confusion and difficulty of use with two scrotal pumping devices; (iii) Surgeon experience and learning curve. Requires more experienced prosthetic urologists; (iv) If the bulbar urethra is considered difficult through the scrotal incision, the surgeon should use the perineal incision for the cuff placement; (v) Infection would potentially necessitate removal of both implants components; (vi) Concerns over the extent of dissection which may further increase the risks of erosion and infection; (vii) Distal placement of the AUS cuff on the thin urethra may be less effective, with a higher early failure rate and revisions due to loosely fitting cuffs and accelerated urethral atrophy	(i) Two incisions; (ii) Previous prosthetic implant may have asymptomatic colonization of the prosthetic device predisposing to infection during insertion of the second implant; (iii) Extra care is needed to avoid damaging the components of the existing implant and its tubing; (iv) Added danger of operating in an area with surgical scarring; (v) Insertion of the sphincter pump from an abdominal incision can be associated with excessive edema or hematoma causing the pump to retract into the upper groin, making long-term use by the patient difficult (high riding pump)