Three-piece inflatable penile prostheses can be safely implanted after radical prostatectomy through a transverse scrotal incision

OBJECTIVES Some surgeons will not offer a three-piece inflatable penile prosthesis (IPP) to patients who have undergone retropubic surgery because of a perceived increase in intraoperative risk during reservoir placement into the retropubic space. METHODS Of 942 consecutive patients undergoing IPP placement from 1986 to 2006, 115 had undergone radical prostatectomy before placement of an American Medical Systems Ultrex (n = 73), CX (n = 34), or CX-M (n = 8) device. Intraoperative and follow-up data for all patients were collected in an institutional review board-approved database. RESULTS All 115 IPP placements were completed as planned and without intraoperative complications, including no injury to the bladder or iliac vessels. An increased amount of scarring often made the fascia more difficult to perforate, but blind entrance into the retropubic space was performed successfully in all cases. Three prosthetic infections (2.6%) and eight mechanical failures (7%) occurred during a median follow-up of 3.3 years. The estimated probability of no infection or mechanical failure at 3 years in this patient cohort was 97.0% and 95.5%, respectively. CONCLUSIONS Retropubic placement of the reservoir of a three-piece IPP was accomplished without intraoperative complications in 115 consecutive postprostatectomy patients, with more than 90% of devices free of mechanical failure at 5 years. Because three-piece IPPs can be placed safely and have been associated with the greatest patient and partner satisfaction rates, we do not believe that-prostatectomy should be a contraindication for placement of the retropubic reservoir of a three-piece IPP through a transverse scrotal incision.