Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Robotic radical prostatectomy in patients with preexisting infl atable penile prosthesis (IPP)

Jamil Rehman¹, Khurshid Guru², Bilal Chughtai³, Ridwan Shabsigh⁴, David Samadi⁵

1 Department of Urology, School of Medicine, SUNY-Stony Brook Health Sciences Center, Stony Brook, New York, USA
2 Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
3 Division of Urology, Albany Medical College, Albany, New York, USA
4 Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA
5 Division of Robotics and Minimal Invasive Surgery, Department of Urology, Mount Sinai School of Medicine and Medical Center New York, New York, USA
Address correspondence to Dr. Jamil Rehman, Department of Urology, Stony Brook University Medical Center, SUNY-Stony Brook, HSC L-9, 040, Stony Brook, NY 11794-8093 USA

Canadian Journal of Urology 2008, 15(5), 4263-4265.

Abstract

Purpose: We present our initial experience with performing robotic-assisted prostatectomies in men with a 3-piece inflatable penile prosthesis with a pelvic reservoir.
Material and methods: Four patients underwent transperitoneal robotic-assisted radical prostatectomies with a penile prosthetic implant in place. The reservoir was left inflated for easy identification. A flaccid reservoir may be more difficult to identify, and be prone to damage. The reservoir was left attached to the abdominal wall. Dissection was performed outside the fibrous capsule of the reservoir. The tissue around the capsule of the reservoir peeled off without difficulty. Cutting current close to the capsule can be used if needed as per American Medical System with no limit to voltage. The penile prosthesis is then inflated to empty the reservoir creating more prevesical space and preventing the reservoir from obscuring visualization. The remaining portion of the procedure is completed using our standard technique. After completing the urethrovesical anastomosis using the 16 French Foley, the prosthesis is cycled under direct vision and the penile prosthesis is deflated (reservoir full). The prosthesis is not used for 6 weeks to prevent stretching of the urethrovesical anastomosis.
Results: All patients (n = 4) had no reported complications and all prostheses are functioning properly. The margin status was negative postoperatively.
Conclusion: Robotic prostatectomy is technically feasible in patients with inflatable penile prostheses by surgeons experienced in robotic surgery. However, the presence of an indwelling penile prosthesis does increase the complexity of surgery.

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