1670 THE FATE OF PATIENTS DEVELOPING ERECTILE DYSFUNCTION AFTER PLAQUE INCISION AND GRAFTING FOR PEYRONIE'S DISEASE

Abstract

required during inflatable penile prosthesis (IPP) insertion to ensure that the penis will be straight enough for penetrative intercourse. The aim of this study was to compare the outcomes of men undergoing SM employed during IPP insertion compared to those wherein these maneuvers were not required. METHODS: A retrospective review of 391 patients undergoing IPP insertion at the Johns Hopkins Hospital from January 2000-December 2011 was performed. Patients in whom some SM was employed (SM, n 93, 23.9% of the overall cohort) were compared to those for whom SM was not required (IPP group, n 297). Comparisons between groups were performed using Chi-square tests for categorical data; the means of continuous data were compared by using the t test and non-parametric alternate if the distribution could not be normalized or the variance was not equal. P-values 0.05 were considered statistically significant. RESULTS: Patients in whom a SM was used were younger (55.4 vs. 62.3 years) and more likely to have Peyronie’s disease, and less likely to have prostate cancer, radical prostatectomy or to have previously used erectile aids (all P 0.05). Mean surgical time in the SM group was longer (173.8 vs. 152.9 minutes, P 0.003). Within the SM group, modeling was performed in 40 (43%), tunical relaxing incisions in 37 (39.8%), and tunical reconstruction in 16 (17.2%) (most commonly using allograft dermis or pericardium, or synthetic gore-tex grafts) patients. There were no significant differences in terms of device infection (P 0.807), mechanical failure (P 0.212) or cylinder erosion (P 0.051). A significantly higher overall rate of tubing or pump erosion (defined as a visible penetration through the skin) was noted in the SM (10/93, 10.8%) vs. the IPP groups (13/297, 4.4%), P 0.022. The median time to device explantation or revision was 463 days (range 2-1908). CONCLUSIONS: IPP insertion in men with penile deformity requiring complex reconstruction to achieve straightening may be done proficiently. While straightening maneuvers may carry elevated risk, they can nevertheless achieve good results with an overall high safety profile.