Abstract Introduction Simultaneous management of erectile dysfunction (ED) and stress urinary incontinence (SUI) after radical prostatectomy remains technically demanding. The combination of an inflatable penile prosthesis (IPP) and an artificial urinary sphincter (AUS) offers an effective strategy to restore both sexual function and continence in a single procedure. While the Coloplast Titan IPP is a well- established option providing reliable rigidity and high satisfaction, the VICTOTM AUS (Promedon) represents an innovative adjustable system. It features a preconnected three-component design with a self-sealing port enabling in-office pressure modulation after implantation. Objective This video showcases, for the first time, the simultaneous implantation of a Coloplast Titan IPP and a VICTOTM AUS, highlighting the technical nuances of this novel combined approach. Methods A 61-year-old male with severe post-prostatectomy ED and SUI (preoperative pad test: 1,500 g; pad count: 5/day) underwent dual implantation of a Titan iIPP and a VICTO AUS. The procedure was performed under general anesthesia using combined perineal and penoscrotal approaches, with particular care to maintain anatomical separation between the two systems and minimize infection risk. The AUS implantation began with complete dissection of the bulbar urethra via a perineal approach. After measuring the urethral circumference and selecting the appropriately sized cuff, the device was prepared by removing air from the system and filling it with 13 mL of saline. The pressure-regulating balloon was positioned intraperitoneally in the abdominal region, and, as the device is preconnected, the AUS was transferred subcutaneously via bluntly dissected tunnels to place the cuff around the urethra and the pump in the scrotum. The Titan cylinders, pump, and reservoir were implanted via a longitudinal penoscrotal incision along the median raphe, following the standard technique, with controlled corporal dilation. Results The surgery was completed without intraoperative complications, with a total operative time of 130 minutes. Postoperative recovery was uneventful, and both devices were activated according to standard timelines. At the most recent follow-up, 4 months after surgery, the patient demonstrated marked improvement in continence, with a postoperative pad test of 60 g and 2 pads/day during moderate-intense activity. Erectile function was restored with satisfactory rigidity and sexual activity. Following activation, the AUS required three adjustments, with a total system fill of 21 mL after the final adjustment. No device erosion, malfunction, or infection occurred. Conclusions Simultaneous implantation of a Titan IPP and a VICTOTM AUS was feasible and safe, supporting this dual approach as a viable option for selected patients with post-prostatectomy ED and SUI. Disclosure No
Poblador et al. (Mon,) studied this question.
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