V07-12 Modified Mini-Jupette Sling for Dynamic Compression in Climacturia and Mild Sui

You have accessJournal of UrologySexual Dysfunction/Infertility/Andrology (V07)1 May 2024V07-12 MODIFIED MINI-JUPETTE SLING FOR DYNAMIC COMPRESSION IN CLIMACTURIA AND MILD SUI Seyed Shayan A. Falasiri, Kashish Khanna, and Rafael Carrion Seyed Shayan A. FalasiriSeyed Shayan A. Falasiri , Kashish KhannaKashish Khanna , and Rafael CarrionRafael Carrion View All Author Informationhttps://doi.org/10.1097/01.JU.0001008932.49144.fd.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Mini-Jupette sling treats climacturia and stress incontinence during placement of an inflatable penile prosthesis (IPP). The traditional approach utilizes an extended corporotomy with a complex closure where the sling is incorporated with the corporotomy closure. We are sharing the modified steps of this technique to allow for easy reproducibility and the addition of titration of urinary incontinence. METHODS: The initial steps for our modified mini-Jupette procedure are nearly identical to the standard penis scrotal inflatable penile prosthesis. One deviation initially is that we place a 12 French foley catheter instead of the standard 16 French as this will be later useful during the tensioning of the sling during later steps. After the stay sutures are placed longitudinally along the corporotomies in the standard fashion, our method involves placing the two ethibond suture at the lateral corners of the corporotomies for a total of 4 ethibond sutures. It is essential at this step to throw the needle outside to inside on these lateral edges, and then back again inside to outside such that the sutures themselves do not exit the corporotomy. Once the ethibond sutures are placed out of the way, the procedure again resembles the standard inflatable penile prosthesis procedure. After the placement of the cylinders and closure of the corporotomies with the pre-placed stay sutures, we then direct attention to creation of the mini Jupette sling. A virtue sling is laid onto the sterile field, and the quadratic limbs are excised to produce a rectangular mesh. The ethibond sutures at the opposite side of the operating surgeon are then threaded through the corners of the mesh. The mesh is parachuted down to the corporotomy, and these sutures are tied down. Next, our modified approach includes the surgeons judgment as to how much to inflate the inflatable penile prosthesis during this next step. If the patient should have only climacturia, then the thought process is to have that implant inflated to 70 or 80% such that the mesh will allow dynamic compression during intercourse. If the patient should have more mild stress urinary incontinence, then the surgeon can exercise clinical judgment to allow for even as low as 30% inflation, which will allow for dynamic compression at partially flaccid states. Next, the 12 French fully catheter is deflated and pulled back to the fossa navicularis, where 2-3 cc are re-instilled into the balloon. A saline bag held at 60 cm the level of patient's pelvis is connected to the Foley catheter. The surgeon then uses an Adson's to tension the sling to the point at which the saline stops dripping. This is then marked, and the sling is fully secured. The remainder of the procedure is unremarkable and identical to the standard penile prosthesis. RESULTS: We have performed successful placement of modified Mini-Jupette in 11 patients with erectile dysfunction associated with bothersome incontinence using the above technique. All patients were extremely satisfied post procedure with respect to both erectile function and urinary continence. There were no reported surgical site infection and no major reported complications in the immediate post operative period in our case series. CONCLUSIONS: The modified Mini-Jupette is feasible, easy to perform procedure, adding only 20-30 minutes with the additional benefit of preventing additional interventions for the patient for additional urinary continence procedures. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e470 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Seyed Shayan A. Falasiri More articles by this author Kashish Khanna More articles by this author Rafael Carrion More articles by this author Expand All Advertisement PDF downloadLoading ...