Two-stage technique for implantation of inflatable penile prosthesis in pelvic cancer surgery

A two-stage technique for implantation of an inflatable penile prosthesis has been developed for patients undergoing radical pelvic cancer surgery. Over the past five years, this method has been utilized in 147 men undergoing radical cystectomies or prostatectomies. The technique involves implanting the reservoir and pump of the prosthesis at the time of the radical cancer operation when the lateral neurovascular bundles of erection are being sacrificed. The reservoir and pump are permanently connected, and the cylinder tubings from the pump are temporarily connected and placed in the subcutaneous tissue overlying the pubis. During a second procedure, usually six to twelve weeks later, the cylinders are implanted infrapubically and connected to the easily located pump tubing. The advantages are several. (1) The pump and reservoir are easily implanted during the pelvic surgery while importantly not adding significantly to the operative time or morbidity of the primary procedure. (2) The reservoir is easily positioned in the pelvis. (3) The scrotum with its contained pump already will be healed when the entire prosthesis is connected, bypassing the initial scrotal pain and edema. (4) Psychologically the patients feel relieved that their erectile dysfunction is being treated immediately. This two-stage technique appears to maximize the gain of early and easy implantation while minimizing the potential problems of concomitant surgery.