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Comparative outcomes of single-incision versus dual-incision techniques in simultaneous penile prosthesis and
Adnan El-Achkar1, Nilson Marquardt Filho2, Craig Cronin1
1Department of Urology, the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 20817, United States.
Introduction:
While outcomes of simultaneous penile prosthesis (PP) and artificial urinary sphincter (AUS) implantation are well documented, comparative data on single-incision versus dual-incision techniques remain limited.
Objectives:
This narrative review aims to synthesize the available evidence comparing clinical outcomes and complication rates between these two surgical approaches in patients undergoing simultaneous dual implantation.
Methods:
A structured literature review of MEDLINE (OVID), PubMed, and the Cochrane Library was performed from database inception through October 2024 to identify studies reporting outcomes and complications following simultaneous PP and AUS implantation. Patients were grouped according to surgical approach: single incision (penoscrotal or perineal) versus dual incision. The reported outcomes included device infection, revision rates, urethral erosion, and mechanical failure. Quantitative outcome ranges and pooled proportions were summarized descriptively.
Results:
Ten studies comprising 269 patients were included. Of these, 167 underwent dual implantation via a single incision, and 102 via dual incisions. The mean age ranged from 58 to 68 years across cohorts, with a median follow-up ranging from 12 to 72 months. Social continence (defined as ≤1 pad per day) in the single-incision group ranged from 72% to 96%, compared with approximately 90% in the dual-incision group. Functional penile prosthesis rates were consistently above 96% in both groups. The single-incision group demonstrated lower reported rates of revision (16.5% vs 30.5%) and mechanical failure (2.8% vs 13.1%) compared with the dual-incision group; however, outcome ranges overlapped substantially across studies. Rates of device infection (4.1% vs 5.1%) and urethral erosion (10.0% vs 7.0%) were similar between surgical approaches.
Conclusions:
Simultaneous PP and AUS implantation via a single incision demonstrates clinical outcomes comparable to the dual-incision technique, with similar rates of infection, urethral erosion, mechanical failure, and revisions. These findings support the feasibility of either approach for simultaneous implantation.
