045 Glandular Necrosis Following Penile Implant: Etiology & Treatment Suggestions

Abstract

Glandular necrosis following penile implant is a very rare complication. The literature has a paucity of information with only single case reports. Glandular necrosis is devastating to both patient and physician frequently precipitating litigation. We report 16 cases following prosthesis implantation (8 rods, 8 inflatable) examining etiology and treatment outcomes with the hope of both prevention & possible treatment suggestions. Each of the patients were reported to the senior author following the complication’s occurrence or discovered as result of expert witness work during malpractice litigation. Glandular necrosis presented with dusky glans on first post op day. The dilemma of immediate removal or continued observation perplexed each surgeon. The blood supply of the glans penis is from dorsal penile arteries and corpus spongiosum muscle. From the patient population we compiled risks and adjunctive surgical maneuvers that might compromise that vascularity. Risk factors detected were severe arteriosclerotic cardiovascular disease (75%), previous removal of implant usually for infection (69%), diabetes (69%), smoking (50%) radiation therapy (50%). All patients demonstrated 4 of 5 (80%) risk factors. Surgical maneuvers considered important during prosthesis placement were coincident subcoronal incision, penile degloving or circumcision (69%), penile wrap with elastic bandage (50%), coincident distal urethral injury repair (25%). Most patients (81%) managed with expectant management i.e., observation & implant preservation, sustained significant glandular loss with resultant 63% successful litigation. Three patients managed with immediate prosthesis removal healed without sequelae.