(115) Mechanical and Anatomic Indications for Inflatable Penile Prosthesis Revision

Abstract

Abstract Introduction Implantation of an inflatable penile prosthesis (IPP) is considered the gold standard for definitive treatment of men with refractory erectile dysfunction. As mechanical devices, IPPs have a finite lifespan, thus often requiring surgical revision or replacement of components over time. Objective To characterize the location of IPP mechanical component failure in patients presenting for revision or explant and stratify them by device manufacturer [Boston Scientific (BSc) and Coloplast (CP)]. Methods A retrospective chart review of our large, single-surgeon, tertiary referral center penile prosthesis database between 2007-2022 was completed to identify all men who underwent IPP revision (partial or full device) or explant. Only cases having intraoperative documentation of cause for IPP failure and device manufacturer were included. Reasons for revision or replacement surgery were categorized into mechanical (tubing, cylinder, or reservoir leak and pump malfunction) and non-mechanical (component herniation, erosion, or crossover). All revisions performed due to non-mechanical reasons were excluded from analysis. Chi-square analysis was used to assess failure rates and causes. A Student’s T-test was used to assess time to revision and demographics. Results Among 933 IPP cases, we identified 133 patients who underwent 272 revision procedures; 154 met inclusion criteria (96 BSc and 58 CP). Forty-four (29%) of those surgeries were revisions of devices placed by outside surgeons, and 110 (71%) were revisions of IPPs inserted at our institution. Average patient age was 67 years for BSc and 63 years for CP (p = 0.086), and the average BMI was 28.7 for BSc and 30.8 for CP (p = 0.122). Time to revision was similar between brands at an average of 39 months for BSc and 56 months for CP (p = 0.11). Eighty-one (53%) of the surgeries were revisions of one affected implant component, 56 (36%) were full device removal/replacement, and 17 (11%) were full explants. Coloplast devices required revision more frequently due to tubing fracture (p < 0.01), and BSc devices required revision more frequently due to pump malfunction (p = 0.02). Both devices rarely failed due to cylinder or reservoir defects (Figure). Conclusions Although time to revision was similar between the two brands, CP devices malfunctioned more often due to tubing fracture whereas BSc devices failed more often due to pump malfunction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast