Evolved improvements in placement of the silicone gel prosthesis for post-prostatectomy incontinence

During the last 2 1/2 years we have used the silicone gel prosthesis for 8 consecutive patients who were incontinent after prostatectomy. Although the prosthesis had to be replaced in 1 instance a satisfactory result has been obtained by each patient. We believe that with minimal patient selection successful results can be achieved in a large majority of such patients by implementing the evolved improvements in prosthesis placement: 1) use 4 serrated knee staples or George Washington modification to improve fixation, 2) release the urethral bulb from the central perineal tendon for better compression and 3) place the prosthesis higher on the ischiopubic rami. Avoidance of urethral erosion is the single most important aspect of the procedure and intraoperative urethral pressure profile may be helpful in this regard. Guidelines regarding the procedure, prosthesis injection and patient management are discussed briefly.