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The use of autologous fascia in the Mini-Jupette graft: two cases

International Journal of Impotence Research volume 32, pages 140–141 (2020)Cite this article

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Climacturia is a type of sexual dysfunction that can occur in up to 64% of men who have undergone radical prostatectomy (RP) [1]. It is defined by the International Society for Sexual Medicine (ISSM) as orgasm-associated incontinence in which there is leakage of urine during ejaculation. The exact prevalence is hard to estimate as climacturia is under-recognized by providers, and patients may be unwilling to report it. It is frequent enough, however, that multiple management strategies exist to treat this problem. Less invasive management strategies for climacturia include behavioral modification, pelvic floor therapy, and pharmacological treatment. Surgical intervention is also an option when more conservative measures have failed.

Because climacturia commonly occurs in conjunction with post-RP erectile dysfunction, treatment of both complaints may be attempted simultaneously with insertion of an inflatable penile prosthesis (IPP). Traditionally, a sub-urethral sling placed at the time of IPP insertion has been used with some success to treat climacturia. However, a sling applies continuous pressure on the urethra at all times, while climacturia is a temporary and infrequent event that occurs only during coitus. More recently, the use of a graft that takes advantage of IPP inflation to obstruct urinary flow has bypassed this issue and achieved excellent success in treating erectile dysfunction associated climacturia [2]. Coined the Mini-Jupette (Fr. mini-skirt) by Robert Adrianne of Belgium, this graft provides intermittent compression of the urethra only during sexual intercourse when the IPP is activated. During surgical placement of the prosthesis, the graft is sutured to the medial corporotomies; as the cylinders inflate, the graft becomes taut providing adequate blockage of the urethra and decreasing urinary leakage. Yafi et al. conducted a multicenter prospective trial investigating the efficacy of this technique and found that the use of the Mini-Jupette significantly improved climacturia in 22 out of 28 patients (79%) with 19 (68%) reporting complete resolution [3]. Furthermore, the complication rate (13%) was comparable to that reported in studies of urethral slings alone (12%) [4].

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Authors and Affiliations

  1. Department of Urology, University of California, Irvine, CA, 94720, USA

    Maxwell Towe, Farouk El-Khatib, Mohamad Osman, Judy Choi & Faysal A. Yafi

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  1. Maxwell Towe
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  2. Farouk El-Khatib
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  3. Mohamad Osman
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  4. Judy Choi
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  5. Faysal A. Yafi
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Correspondence to Faysal A. Yafi.

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Towe, M., El-Khatib, F., Osman, M. et al. The use of autologous fascia in the Mini-Jupette graft: two cases. Int J Impot Res 32, 140–141 (2020). https://doi.org/10.1038/s41443-019-0178-z

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