COMPARATIVE EFFECTIVENESS OF SIMULTANEOUS AND STAGED SURGICAL INTERVENTIONS FOR ERECTILE DYSFUNCTION AND STRESS URINARY INCONTINENCE

Introduction. The evolution of surgical approaches is reflected in a shift toward simultaneous surgeries aimed at addressing multiple clinical issues. Despite the effectiveness of radical prostatectomy in the treatment of prostate cancer, it leads to functional complications (urinary incontinence 1–87%, erectile dysfunction 25–85%), significantly affecting quality of life. The comprehensive correction of these complications remains a priority, as it determines not only physical recovery but also the psychosocial adaptation of patients. Objective. To evaluate the effectiveness of combined surgical correction in the form of a single-stage implantation of a semi-rigid penile prosthesis and a male transobturator sling for the restoration of erectile function and urinary incontinence in patients after radical prostatectomy. Materials and Methods. A prospective analysis of 60 patients with moderate postoperative stress incontinence (77–151 g/24 h according to the Pad test) and severe erectile dysfunction (5 points according to IIEF-5) after radical prostatectomy was performed. The study design included randomization into two groups: Group 1 (two-stage correction, n = 30) – penile prosthesis, 3-month outpatient pause, installation of a male sling; Group 2 (single-stage treatment, n = 30) – single-stage penile prosthesis and installation of a male sling. Diagnostics included determination of PSA, general urine analysis, ultrasound, Pad test, questionnaires according to IIEF-5, ICIQ-SF, I-QoL and HADS (anxiety and depression). Observation was carried out after 1, 3, 4 and 6 months, with an assessment of postoperative changes. Results. Groups 1 and 2 were comparable in age (62.8 ± 3.7 and 62.8 ± 3.7 years), BMI (28.4 ± 2.0 and 27.9 ± 2.0 kg/m²), oncological status (PSA <0.05 ng/ml) and comorbidity. Baseline indicators of incontinence (Pad test: 112.7 ± 21.2 and 114.8 ± 21.8 g/24h; ICIQ-SF: 9.2 ± 1.6 and 8.9 ± 1.6 points), quality of life (I-QoL: 57.3 ± 8.8 and 57.7 ± 8.3 points) and psychoemotional status (HADS anxiety: 10.5 ± 1.9 and 10.3 ± 1.7; HADS depression: 10.3 ± 1.9 and 10.0 ± 1.7 points) did not have differences (p>0.05). The correction was characterized by a statistically shorter duration of the intervention than the sum of the two stages of the operations (83.0 ± 3.2 and 93.8 ± 11.7 min, p = 0.0001) with a comparable safety profile. In Group 2, a more rapid improvement was achieved: normalization of the Pad-test and ICIQ-SF indicators by 1 month versus 4 months in Group 1. Quality of life (I-QoL) in Group 2 improved significantly after 1 month (80.0 ± 4.0% and 57.3 ± 8.8% in Group 1, p <0.05). The psychoemotional state (HADS) in Group 2 normalized by 3 months, while in Group 1 only by 6 months (p = 0.0002). By 6 months, the differences leveled out, achieving a comparable final efficacy. International experience demonstrates the effectiveness of simultaneous surgeries for the correction of erectile dysfunction and incontinence, which is consistent with our results. According to Valenzuela et al. (2019), single-stage correction provides improvement in 93% and 85% of patients, respectively, without increasing the risk of complications. The experience of simultaneous surgeries in Russian urology remains poorly studied. Conclusions. Single-stage correction ensures accelerated rehabilitation with an early improvement in quality of life and psychoemotional status with comparable long-term effectiveness and safety comparable to a two-stage approach.